Gabriel A, Apostolides J, Nickodem A, Rad AN, Patel V, Zaw R, Martin S, Harris N, Jones G, Nahabedian MY. Patient experience with different implant breast reconstruction surgeries. Poster presented at the ISPOR 2019; May 20, 2019. New Orleans, LA.

OBJECTIVES: Innovations in prosthetic breast reconstruction have led to new techniques for use following mastectomy. Current strategies focus on the variable location of the breast implant and include prepectoral (above the pectoralis major muscle), dual-plane (partial subpectoral) and total subpectoral. Here we present patient-reported outcomes from patient interviews designed to assess experience of prepectoral, dual-plane and revision (dual-plane to prepectoral) prosthetic breast reconstruction.

METHODS: Literature review and surgeon interview results were summarized and used to develop a semistructured patient interview guide. Women who underwent implant-based breast reconstruction and met eligibility criteria attended 1-hour telephone interviews to review their experience after reconstruction. Results were evaluated using thematic analysis.

RESULTS: Three surgeons were interviewed and stated that aesthetic, pain, and mobility outcomes were superior following prepectoral versus dual-plane placement. Twenty patients (10 prepectoral; 4 dual-plane; 6 revision) were interviewed. Through Week 1 after surgery, commonly reported outcomes included:

  • positive: less pain than expected (prepectoral, 7/10 [70%]; dual-plane, 2/4 [50%]; revision, 1/6 [17%]); breast appearance (prepectoral, 1/10 [10%]; dual-plane, 2/4 [50%]; revision, 5/6 [83%]).

  • negative: restrictions/inability to perform daily tasks (prepectoral, 5/10 [50%]; dual-plane, 4/4 [100%]; revision, 1/6 [17%]) and pain in breast/chest area (prepectoral, 4/10 [40%]; dual-plane, 3/4 [75%]; revision, 2/6 [33%]).

Through Month 3, the most commonly reported:

  • positive outcomes were ability to perform daily tasks/exercise (prepectoral, 7/10 [70%]; dual-plane, 1/4 [25%], revision, 2/6 [33%]); breast appearance (prepectoral, 3/10 [30%]; dual-plane, 3/4 [75%]; revision, 6/6 [100%]).

  • negative outcome was pain in breast/chest area (prepectoral, 1/10 [10%]; dual-plane, 2/4 [50%]; revision, 2/6 [33%]).

CONCLUSIONS: These qualitative interviews identified pain, ability to perform tasks, and breast appearance as key outcomes after implant-based breast reconstruction. Patient reported-outcomes were consistent with those reported by surgeons. Large-scale survey studies are needed to quantify the differences between surgical techniques in these key outcomes.

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