Understanding the Recovery Phase of Breast Reconstruction: Patient Reported Outcomes Correlated to Type and Timing of Reconstruction
Katie E. Weichman, MD1, Jennifer B. Hamill, MPH2, Hyungjin Kim, MS2, Xiaoxue Chen, MS2, Edwin G. Wilkins, MD, MS2, Andrea L. Pusic, MD, MHS3.
1Montefiore Medical Center/Albert Einstein School of Medicine, Bronx, NY, USA, 2University of Michigan, Ann Arbor, MI, USA, 3Memorial Sloan Kettering Cancer Center, New York, NY, USA.
During preoperative discussions with breast reconstruction patients, questions often arise about the recovery period. However, there is a paucity of data on expected pain, fatigue and physical morbidity after reconstruction. We sought to evaluate how recovery varies based on the timing and type of reconstruction.
Patients were recruited for the Mastectomy Reconstruction Outcomes Consortium (MROC) Study, a prospective, multi-centered NIH-funded study (1RO1CA152192). Patients completed the Numerical Pain Rating Scale (NPRS), McGill Pain Questionnaire, and Breast-Q preoperatively and at one week and three months postoperatively. Pain, fatigue, and physical distress were evaluated by type and timing of reconstruction.
A total of 2,013 patients completed surveys. Pain, fatigue, and physical distress varied significantly across procedures at one week and three months. At three months, pain measured by the NPRS was greater in patients with tissue expanders/implants (TEs/Is), compared to deep inferior epigastric artery perforator (DIEP) flaps and to direct to implant (DTI) procedures (2.3 versus 1.9 (p<0.005) and 1.5 (p<0.001)). Similarly, at three months, physical distress, as measured by BREAST-QTM, was less for DIEP, compared to both free transverse rectus abdominus myocutaneous flaps and TEs/Is (73.5 versus 71.3 (p=0.01) and 68.8 (p<0.0001)), and DTI compared to TEs/Is (71.8 versus 68.8 (p<0.05)). Additionally, patients who received immediate reconstructions, compared to delayed, experienced more pain and physical distress at one week. However, this difference equalized at three months.
Postoperative pain, fatigue, and physical distress vary significantly by reconstructive procedure. Additionally, patients generally have not fully recovered at three months post-surgery.
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