Evaluation Of Aesthetic Results And Patient-Reported Outcomes After Implant-Based Breast Reconstruction

Background:Global cancer statistics indicate that breast cancer is the most common malignancy and the leading cause of cancer-related death among women.Traditional modified radical mastectomy will not only cause breast loss,but also may lead to a series of social psychological problems such as loss of confidence and lower self-identity.Under the premise of tumor safety,breast reconstruction can help patients to improve their aesthetics and quality of life.Currently,the main methods of breast reconstruction include implant-based breast reconstruction,autologous reconstruction and implant combined with autologous reconstruction.Among these methods,implant-based breast reconstruction is the most applied one.The evaluation of aesthetic results and patient-reported outcomes after breast reconstruction for breast cancer patients can not only reflect their breast shape,quality of life and satisfaction,but also guide and optimize the surgeons’clinical decision.An ideal aesthetic results evaluation tool should be objective,repeatable and have good correlation with patient-reported outcomes.With the development of new technology,more evaluation tools are proposed,verified and applied.Objective:Postoperative aesthetic results of implant-based breast reconstruction were evaluated by subjective and objective assessment tools,and patient-reported outcomes were collected to analysis their correlation and respective influencing factors.Methods:Data about patients who were pathologically diagnosed with breast cancer in the Second Hospital of Jilin University from August 2009 to April 2019,who had received implant-based breast reconstruction,and had completed follow-up information were collected to conduct this study.Patients were invited back to the hospital for further follow-up by telephone.Two-dimensional photos of the patients’breasts were collected and then five chief physicians or senior attendings of our department were invited to grade them according to Harris aesthetic evaluation criteria.Additionally,objective evaluation was conducted through BCCT.core software.All patients received three-dimensional scanning and obtained images.Through Geomagic Wrap software,we were able to calculate the breast volume and further figured out the volume symmetry coefficient.The BREAST-Q questionnaires were distributed and withdrawn to assess patients’quality of life and satisfaction.Statistical software was used to analyze their correlation and respective influencing factors.Results:1.45 patients were finally enrolled in our study,with an average age of 42.0±7.7years and an average age of 38.5±6.8 years at surgery.The median follow-up time was34 months(range 6-123 months).2.Final evaluation results of Harris score indicate that 12 patients(26.7%)were Excellent,18 patients(40.0%)were Good,13 patients(28.9%)were Fair,2 patients(4.4%)were Poor.For measurement of the agreement between 5 observers(inter-observer reliability)the weighted kappa value was 0.70,which corresponded to a good agreement between panels(p<0.001).3.BCCT.core software evaluation results show that 8(17.8%)patients were Excellent,19(42.2%)patients were Good,16(35.6%)patients were Fair,and 2(4.4%)patients were Poor.4.The median of breast volume symmetry coefficient of was 0.837(Q_R=0.237,range:0.303-0.999).5.Harris score is strongly correlated with BCCT.core score(r=0.676,p<0.001),and the volume symmetry coefficient was weakly correlated with both Harris score(r=0.333,p=0.026)and BCCT.core results(r=0.383 p=0.009).In the Harris score of Excellent/Good group,all symmetry indexes of the BCCT.core software were smaller than those of the Fair/Poor group,indicating better breast symmetry.6.On the multivariate linear regression,bilateral reconstruction was the most favorable predictor of aesthetic results which had a positive effect on the results of the three evaluation methods.Radiotherapy was a poor predictor of both Harris score and volume symmetry coefficient.In addition,chemotherapy and follow-up time over 36months were separately unfavorable and favorable predictors of BCCT.core results.These factors can predict the results of Harris score,BCCT.core score and volume symmetry coefficient by 25.4%,42.0%and 27.3%respectively.7.Satisfaction with surgeons,satisfaction with staff and satisfaction with other members in medical team were the highest scores among the BREAST-Q questionnaire,with a median of 100.The lowest scores were sexual wellbeing(median=59,Q_R=28.5)and satisfaction with breast(median=58,Q_R=18.5).8.Breast satisfaction was weakly correlated with sexual health(r=0.314,p=0.035)and satisfaction with staff(r=0.365,p=0.014)and moderately correlated with satisfaction with information(r=0.599,p<0.001).9.Linear regression results show that there was no significant linear correlation between aesthetic results of Harris score(p=0.89),BCCT.core score(p=0.79),volume symmetry coefficient(p=0.27)and satisfaction with breast.Conclusion:1.BCCT.core software is an effective objective evaluation tool and has a strong correlation with the subjective evaluation results.2.Three-dimensional scanning is able to quantify breast volume,and the volume symmetry coefficient can be used as an auxiliary evaluation index,while other factors should be considered in the overall evaluation as well.3.Bilateral breast reconstruction and long-term follow-up were favorable predictors of cosmetic outcomes,while radiotherapy and chemotherapy had adverse effects.4.BREAST-Q questionnaire can directly reflect the quality of life and satisfaction of patients.Breast satisfaction is related to sexual health,satisfaction with staff and satisfaction with information.Our results may contribute the improvement of subsequent clinical work.5.Although there was no significant correlation between aesthetic results and satisfaction with breast in this study,good cosmetic outcomes are still worth a trial.