Breast reconstructive surgery: Risk factors for complications and health-related quality of life - Clinical studies

Abstract

Background: Breast cancer is the most common form of cancer in women worldwide. Although the incidence is increasing, the mortality rate is not. This results in a growing number of breast cancer survivors, and thereby in increasing demand for breast reconstructions. Complications after breast reconstructive surgery are common and can be caused by a wide range of factors, such as the reconstructive method, perioperative factors and patient-related factors. As the principal aim of breast reconstruction is to reverse the mastectomy deformity and restore body image and health-related quality of life (HR-QoL), traditional clinical outcome measures, such as medical or surgical complications, do not suffice assessing the values of different reconstruction methods for the patient. There are no established guidelines on choosing the best reconstruction method for the individual patient. However, patient perspectives and experiences are important when choosing the reconstructive method, and HR-QoL needs to be investigated in a systematic way when comparing different reconstruction methods. Aim: The aim of this thesis is to evaluate postoperative complications, to find independent risk factors for complications and compare HR-QoL between breast reconstruction patients, and with the general population. Method: The four retrospective studies are based on a large database of breast reconstructions between the years 2003 and 2009 at the Department of Plastic Surgery, Sahlgrenska University Hospital, and results of HR-QoL questionnaires from patients surgically treated with breast reconstruction during this time. Results: Paper I states the importance of a systematic and meticulous registration of complications in comparisons of different methods. The study revealed high complication rates with all of the methods, and the spectrum of complications was related to the operation method, where the DIEP group had the highest rate. The pattern of occurrence of complications ranged between early and late time points. Paper II shows the perioperative factors of duration of surgery and blood loss during surgery as independent risk factors for several postoperative complications, both early and late. Paper III shows several patient-related factors and adjuvant therapy as independent risk factors for complications, such as BMI, smoking, and radiotherapy. Paper IV shows that patients reconstructed with a DIEP flap are more satisfied with their reconstruction and overall outcome than patients in the other groups. Conclusion: Complications after breast reconstructive surgery are common and can be caused by many different factors. Patients reconstructed with a DIEP flap are more satisfied with their reconstruction than patients reconstructed with other methods. To maximize patient satisfaction, DIEP flaps should be more widely available, and complications rate after this type of surgery should be minimized.