28 Chapter 2 Patient satisfaction is considered an important outcome measure following OPS, which was evaluated with the BREAST-Q BCT module in this study. In all domains, scores were above average. The lowest scores were found in the domains ‘sexual well-being’ and ‘physical well-being of the chest’, both with a median score of 56, with ‘sexual well-being’ having a lower response rate (65.4%). This is similar to the findings in the study by Rose et al,25 where they compare BREAST-Q outcomes after OPS and breast-conserving surgery. Overall, patients were satisfied with their breasts and with psychosocial well-being, with a median score of respectively 65 and 63 in these domains. However, other studies on this topic showed better outcomes as compared to this present study.26, 27 Yet, there are notable differences compared to our study: patients were either younger, various types of reconstructions were included or small breasts (cup B or smaller) were excluded. When evaluating global aesthetic judgment, patients were satisfied with a score from fair to excellent in 96%, which was 75-95% by panel evaluation. This was in line with a study by Clough et al,28 in which a panel used a similar grading system to evaluate cosmetic outcomes of 101 breast cancer patients who underwent OPS with volume displacement, at two and five years follow-up 88% and 82% scored fair to excellent. The baseline comparison between volume replacement and volume displacement, showed significant differences in the location of the tumor and in contralateral symmetrizations. This was expected as the volume replacement technique is most often used in patients with smaller breasts and laterally located tumors, where adjacent tissue is used to fill the defect, leading to little asymmetry without the need for contralateral symmetrizations. No differences in complications were found between the groups. After volume replacement a lower score in the BREAST-Q domain ‘physical well-being of the chest’ (median score 38 vs 63) was reported, which is probably due to the more extensive surgery and the donor site morbidity, compared to the displacement group. As expected, subgroup analysis showed a significant higher score of mammary symmetry in the volume replacement group (median 2.8 vs 2.2, P=0.048). Outcomes of patients with and without clinically relevant complications were compared. BREAST-Q results showed that patients with complications were less satisfied with the breast and with the information about the surgery. The need for adequate preoperative information was emphasized in previous research in which patients after failed breast reconstructions were interviewed.29 As for cosmetic outcomes, patients with complications had lower mammary symmetry scores, reported by the patients and specialists, and lower global aesthetic judgment scores, reported by the laymen. Presented results imply that complications have a negative impact on patient satisfaction and on the cosmetic outcomes after
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