Women Undergoing Breast Reconstruction with Their Own Tissue Are Happier

Breast cancer surgery followed by reconstruction using a woman’s own tissue carries a higher chance of complications, but according to two studies in JAMA Surgerypublished in June 2018, these women feel better and have higher satisfaction than those choosing implants such as silicone.

“These studies are vital to shared decision-making with physicians when both autologous (own tissue) and prosthetic (artificial) reconstruction are options,” say authors Dr. Kenneth Fan and Dr. David Song.

The first study compared, across 11 sites in 2343 women, breast reconstruction techniques after cancer surgery for 2-year complication rates.

Among these patients;

• 1525 (% 65,1) had expander-implant (EI) reconstruction,
• 112 (% 4.8) had direct-to-implant (DTI) reconstruction
• 85 (% 3.6) had pedicled transverse rectus abdominis myocutaneous (pTRAM) flaps (back muscle tissue),
• 95 (% 4.1) had free transverse rectus abdominis myocutaneous (fTRAM) flaps;
• 390 (% 16.6) had deep inferior epigastric perforator (DIEP) flaps (abdominal muscle tissue);
• 71 (% 3.0) had latissimus dorsi (LD) flaps (back muscle), and
• 65 (% 2.8) had superficial inferior epigastric artery (SIEA) flaps.

Thus, %70 had implant reconstruction and %30 reconstruction with their own tissue.

Overall complication rate was %32.9. Reoperative complications occurred in %19.3 and wound infections in %9.8. Analysis after 2 years found that women receiving autologous reconstruction were not more likely to develop complications than those choosing prosthetic techniques.

However, subgroup analysis showed complications in %26.6 with expander implants versus % 73.9 with SIEA flaps. Reoperative complication rates rose from %15.5 with expander implants to %30.8 with SIEA reconstruction.

Surprisingly, reoperation-related complication rates resembled those reported 15 years earlier.

Overall, reconstruction failure occurred in only %5.4. Failure was higher with implants at %7.1 than with all other procedures; for example, pTRAM flaps had %1.2. Overall wound infection was % 9.8 (FTRAM flaps %5.3; direct-to-implant reconstruction %15.2).

In summary, regarding overall and repeat complications, researchers found no significant differences between reconstruction types. This information is critical to women and surgeons making reconstruction decisions.

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Women Choosing Reconstruction with Their Own Tissue Have Higher Satisfaction

In the second study, Dr. Andrea Pusic and colleagues used BREAST-Q in 2013 women to assess satisfaction and breast-related quality of life 2 years after reconstruction with implants or autologous techniques.

Women receiving autologous reconstruction were more satisfied with their breasts and had higher psychosocial and sexual well-being.

Pusic and colleagues said, “These findings can inform patients and clinicians about expected satisfaction and quality-of-life outcomes from autologous and implant-based procedures, and further support shared decision-making in practice.” they said.

Since 2000, however, interest in implants for reconstruction has been greater. It is suggested this United States trend may reflect lower financial returns from autologous transfers compared with implants.

The study also showed higher rates of immediate revision with a second operation soon after autologous reconstruction, but fewer delayed revisions.

Conclusion

Breast cancer is the most common cancer in women, and most cases are now diagnosed early, increasing interest, demand and need for reconstruction. Many patients choose reconstruction after treatment and are highly satisfied; some even report an appearance more satisfying than before. Many options, however, can be confusing. In this area where decisions can be difficult, these two large multicenter studies offer valuable information. Important advantages of choosing one’s own tissue have now been demonstrated. They support reconstruction decisions made jointly with physicians according to individual preferences and disease features.

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