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Patient-PhysicianDisparity in Breast Reconstruction Aesthetic Outcomes: Chasing the Elusive “Great” Result
Eliana Duraes, MD1, Stephanie Kortyka, MD1, Leonardo Duraes, MD, PhD1, Megan Morisada, BA1, Susan Orra, MD1, Joao Batista Sousa, MD, PhD2, Risal S. Djohan, MD1, Steven Bernard, MD1, Andrea Moreira, MD1, Graham S. Schwarz, MD1.
1Cleveland Clinic, Cleveland, OH, USA, 2Brasilia University, Brasilia, Brazil.

PURPOSE: Identify factors associated with disparity in the perceived reconstruction result by comparing patient satisfaction with their breasts and aesthetic outcomes as judged by physicians.
METHODS: Patients with completed breast reconstructions of all types from 2009-2011 completed BreastQ questionnaires. Postoperative photos were graded by a six member panel using a breast reconstruction-specific aesthetic scale. Scores from the BreastQ domain “satisfaction with breasts” (BrSat) were compared with the photo-based grades (PhotoGr). Patients were categorized: Group 1, BrSat >PhotoGr; Group 2, BrSat =PhotoGr; Group 3 patients BrSat<PhotoGr. Demographics, additional BreastQ domain scores, and surgical data were used in the analysis.
RESULTS: Of 820 patients, 261 answered the questionnaires and 147 had photos graded. BrSat was positively correlated with PhotoGr (Pearson correlation 0.32, p<0.001). Group 1 demonstrated higher (p≤0.05): psychosocial, physical and sexual well-being on BreastQ compared with Groups 2 & 3. Group 1 exhibited a higher number of two stage implant-based reconstructions. Group 3 showed more non-abdominally based flaps, direct to implant and immediate autologous reconstructions. The following factors did not influence associations between BrSat and PhotoGr (p≥0.05): BMI, depression, radiation, post-operative complications, reoperations due to complications, secondary reconstructions, and reconstructions initiated in other institutions.
CONCLUSION: Patient satisfaction with breast reconstruction aesthetic outcomes is positively influenced by QOL domains and surgical factors not directly related to aesthetics which may predispose patients to grade their results higher than surgeons. Patients graded their two stage implant reconstructions higher than physicians, while physicians graded immediate autologous reconstructions and non-abdominally based flaps higher than patients.


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