The Mastectomy Reconstruction Outcomes Consortium (MROC) is a 5-year, prospective, multicenter study designed to address knowledge gaps in breast reconstruction outcomes research. A recent MROC substudy prospectively evaluated patient satisfaction and quality of life 1 year after mastectomy, comparing reconstruction with autologous (tissue flap) procedures and breast implants.
- Included 1,632 patients of 57 plastic surgeons at 11 locations (9 academic institutions and 2 community sites.
- Survey participants were 18 years or older and had immediate reconstruction (at the same time as their mastectomies).
- Mastectomies were performed to treat breast cancer. (Women who had prophylactic mastectomy and reconstruction were not included in this study.)
- 139 (70%) had implant reconstruction, either direct-to-implant or with tissue expanders.
- 493 (30%) had reconstruction with an abdominal flap: pedicled TRAM, free TRAM, DIEP or SIEA.
This research is thought to be the largest prospective study to-date of patient-reported outcomes that reflect quality of life after immediate breast reconstruction.
One year after their breast reconstruction, women who had breast reconstruction with implants expressed the same level of satisfaction as they did before they entered the operating room.
In contrast, women who had flap reconstruction were more satisfied than they were before their surgery. This might seem odd, given that reconstructed breasts have little sensation. However, many women are unhappy with size, position, sagging, asymmetry, or other cosmetic aspects of their natural breasts and overall body image. Study authors noted that, ‚ÄúThis improvement may relate to the fact that patients who are eligible for flap reconstruction often have higher BMIs and large breasts. In such patients, reconstruction often is accompanied by a contralateral symmetrical breast reduction, and this might contribute to patient happiness about the size and shape of their breasts overall.‚Äù
More concerning is the finding that physical well-being in the chest and physical functionality continued to be an issue 1 year post-op for women in both groups. Patients reported pain and tightness that remained after 1 year (women with implants reported more symptoms than their counterparts who had flap reconstruction). According to the study authors, ‚ÄúThese results likely relate to that the significant nerve disruption from surgery and that requirement of elevation of the pectoralis, and often serratus, muscle for implant reconstruction.‚Äù Women who had abdominal flaps also had problems at the 1-year mark, reporting abdominal discomfort and weakness.
Pusic AL, Matros E, Fine N, et al. "Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study.‚Äù Journal of Clinical Oncology. 2017 March 27. [Epub ahead of print]