Breast-Q sensory outcomes of non-neurotised, autologous, unilateral breast reconstruction with minimum 3-year follow-up

SummarySensory reinnervation of autologous breast tissue after free flap reconstruction is highly variable. There no long term follow up data exploring spontaneous and how this affects patients’ quality life nor the nerve-related symptoms they experience. To address we invited patients at a minimum 3 years since non-neurotised, free-flap to complete patient-reported outcome measures sensation, breast-related symptoms.MethodsWe performed retrospective cohort study undergoing unilateral MS-TRAM or DIEP between 01-01-2015 31-12-2019 in Department Plastic Reconstructive Surgery Manchester University NHS Foundation Trust. Participants were recently developed Breast-Q© Breast Sensation Module.ResultsAll had undergone immediate (n=85) delayed (n=82) mastectomy using either (n=150) TRAM (n=17) prior. The median age operation was 48. significantly reduced reconstructed compared contralateral (P<0.0001) with reduction reported (immediate (68.0 [54.0, 89.0]) [62.0, 83.8])). better vs procedures (P=0.024). Sensory scores increased (P=0.036).DiscussionBreast sensation non-neurotised greatly follow-up life. A set for quantification required prospective research into cost-benefit neurotised, needed. symptoms. We Module. All (P=0.036). Autologous has become increasingly popular over past 20 excellent aesthetic results general patient satisfaction alternative reconstructive options.13Yueh J.H. Slavin S.A. Adesiyun T. Nyame T.T. Gautam S. Morris D.J. Tobias A.M. Lee B.T. Patient postmastectomy reconstruction: comparative evaluation DIEP, TRAM, latissimus flap, implant techniques..Plast Reconstr Surg. 2010; 125: 1585-1595Crossref PubMed Scopus (0) Google Scholar most common donor site remains abdomen deep inferior epigastric artery perforator (DIEP) gold-standard option due superior clinical outcomes,6Ochoa O. Chrysopoulo M. Nastala C. Ledoux P. Pisano Abdominal wall stability complications does body mass index make difference? Analysis 418 639 flaps..Plast 2012; 130: 21e-33eCrossref Scholar, 7Sawyer J.D. Franke J. Scaife Sommer N.Z. Neumeister M.W. Reconstruction Associated Lower 90-day Readmission Rates..Plastic – Global Open. 2022; 10e4112Crossref (3) although other sites such as inner/lateral thigh, gluteal lumbar regions offer suitable where abdominal unsuitable.2Garza 3rd, R. Ochoa Post-mastectomy Tissue: Current Methods Techniques..Plast Surg Glob 2021; 9e3433Crossref (4) recovery variable evidence reported, however these studies have often contained few limited their long-term up, less than surgery.1Beugels Cornelissen A.J.M. Spiegel A.J. Heuts E.M. Piatkowski A. van der Hulst Tuinder S.M.H. innervated non-innervated reconstructions: systematic review..J Plast Aesthet 2017; 70: 1229-1241Abstract Full Text PDF Neurotisation through neurorrhaphy anterior cutaneous branch intercostal nerves T10-12 (flap) lateral 4th 5th (chest wall) offers potential faster more sensory flaps.1Beugels However, neurotisation flaps during yet standard practice. This part lack robust justify additional operating steps time.8Shiah E. Laikhter Comer C.D. Manstein S.M. Bustos V.P. Bain P.A. Lin S.J. Neurotization Innervated Reconstruction: Systematic Review Techniques Outcomes..J 75: 2890-2913Abstract sought investigate autologous, unilateral, abdominal-based longer (minimum years) recovery, of, impacted also looked what symptoms, if any, validated Module.10Tsangaris Klassen A.F. Kaur M.N. Voineskos Bordeleau L. Zhong Broyles Pusic A.L. Development Psychometric Validation BREAST-Q Module Women Undergoing Post-Mastectomy Reconstruction..Ann Oncol. 28: 7842-7853Crossref (8) Our follows Strengthening Reporting Observational Studies Epidemiology (STROBE) criteria handling followed local National Health Service Audit Research guidelines. requiring Muscle-Sparing Transverse Rectus Abdominus Muscle (MS-TRAM) Wythenshawe Hospital, Trust participate. records retrieved from institutional audit office International Classification Disease (ICD) 11th Revisions codes B39.1 (free TRAM) B39.3 DIEP) primary and/or secondary procedures. Patients contacted by telephone ensure correct address. questionnaire containing unmodified scales sent each via post stamped-addressed envelope allow return completed questionnaire. Specifically, participants asked Breast-Q©-Breast Scale in-regards again non-reconstructed breast. In addition, Sensation: Quality Life Impact scale Symptoms scale4Klassen , Cano . ( 2023 ). "Breast-Q|Breast Cancer." Retrieved November, 2021, 〈https://qportfolio.org/breast-q/〉.Google Scholar. Returned questionnaires lead author who converted raw domain Rasch Transformed (RT) (0 100) individual cross-reference tabulation charts. Only fully included. Higher indicated greater fewer “symptoms” summary then entered an Microsoft Excel™ spreadsheet along patient, time operation, whether procedure further surgery on guidance Breast-Q that minimally important difference score 4 points (Rasch score) clinically relevant.12Voineskos S.H. Gibbons C.J. Giving Meaning Differences Scores: Minimal Important Difference Patients..Plast 2020; 145: 11e-20eCrossref Observed are presented [interquartiles] count (%). Analyses included mixed effects linear models, quantile regression Mann-Whitney U- statistics. For outcomes, models late reference categories. Results differences 95% confidence intervals (CI) Bonferroni corrections multiple applied appropriate. components analysed Friedman one-way analysis Dunn comparison Effects explored covariates multivariable appropriate interaction terms. Significance defined P<0.05 (two-sided). Stata 17.0 (Stata Inc., College Station, TX, USA) Number Cruncher Statistical System (NCSS) 2020, (NCSS Kaysville UT, used analysis. total 316 take 01-03-2022 30-09-2022 Surgery, 167 returned investigator reconstruction. operations 1st January 2015 31st December 2019 one six plastic consultants. 51 48 (median non-responders 49). Seven seven group went symmetrising (reduction mammoplasty mastopexy). RT higher control (non-reconstructed) both reconstructions (P<0.0001). (P=0.024) (Fig. 1). demonstrated significant 83.8]) (P=0.43) 2a). questions (1-4) 4, whereas (5-8) 2b). These related domains of: “feel about body”, “choice clothes”, “how bras feel” “sexual life”. From (74.0 [63.0, 85.0]) (77.0 [64.0, (P=0.86) 3a). (1-14) question (15) 3b). “unnatural feeling” 4) effect which increase side (P=0.16). high neurotised reconstruction, recent review demonstrating inconsistencies terms times, sub-group analyses (flap type method), randomisation groups all risk methodological biases.8Shiah study, there breasts women 1, P<0.0001). Immediate improved been similar when undertaken.3Hamilton K.L. Kania K.E. "Post-mastectomy restoration." Gland.Surgery. 10: 494-497Google It not clear why occurs9Tindholdt Tønseth K.A. Spontaneous reconstruction..Scandinavian Journal Hand Surgery. 2008; 42: 28-31Crossref (30) but could be skin surrounding scarring skin/free interface patients. Delayed may radiotherapy associated nerve damage chest sensation5Lundstedt D. Gustafsson Malmström Johansson K.-A. Alsadius Sundberg Wilderäng U. Holmberg Anderson H. Steineck G. Karlsson 10–17 cancer randomised SWEBCG91-RT trial..Radiotherapy Oncology. 97: 281-287Abstract prevent axonal regrowth wall. four 2) (patients’ affected them “a little” week) were: “bras tissue, changes structure, appearance dynamic occurred loss suspensory ligaments. will impact proprioceptive feedback affect feel”. clothes” life” addition its even recovery. Few abnormal 3) our period 74 [immediate] 77 [delayed] P=0.86). symptom (patients experienced did report any possible neurotisation. Of note, found positive relationship increasing ((8.03 + 0.45 per year; P=0.036) [Fig. 4]), change expect given capacity regeneration deteriorates age.11Verdú Ceballos Vilches J.J. Navarro X. Influence aging peripheral function regeneration..J Peripher Nerv Syst. 2000; 5: 191-208Crossref older satisfied occurs younger acutely aware occurred. objective measure use assess it unclear requirements need defining before specific can defined. Given definition breast, authors chose utilise validated, sensory-specific measure. Its highlighted areas would aid surgeons, researchers. unable weight outcomes electronic within trust. therefore consider future understand size impacts North West England. Regional cultural area multi-centred order account differences. versus reconstructions. appears regardless timing years. believe determine improve centres different cohorts. once complete, propose double-blinded (patient observer) randomised-control trial (innervated non-innervated) utility United Kingdom.