The Metamorphosis of Patient Priorities Throughout the Breast Reconstruction Process

Area of Science:

• Plastic Surgery
• Patient-Reported Outcomes
• Quality of Life Research

Background:

• Breast reconstruction is a complex, multi-stage process heavily influenced by patient preferences.
• Understanding evolving patient goals is crucial for optimizing reconstructive surgery outcomes.

Purpose of the Study:

• To evaluate changes in patient priorities during the breast reconstruction journey.
• To analyze how factors like survival, restitution, symmetry, and enhancement are prioritized over time.

Main Methods:

• Fifty women undergoing immediate breast reconstruction completed quality of life surveys at multiple time points: preoperatively, 3, 6, 12 months post-surgery, and 10 years later.
• Patient priorities were assessed across four domains: survival, restitution, symmetry, and enhancement.
• Mixed-effects regression models and Tukey's HSD tests analyzed the relationship between time and priority scores.

Main Results:

• Survival and restitution scores decreased significantly within the first year, while symmetry and enhancement scores initially increased before returning to baseline.
• Patient priorities showed significant changes over time, with a notable shift towards aesthetic concerns in the first year post-surgery.
• Long-term follow-up at 10 years revealed that patient priorities largely reverted to their preoperative state.

Conclusions:

• Patient priorities in breast reconstruction evolve significantly in the first year, with a temporary increase in focus on aesthetic enhancement.
• Despite short-term shifts, long-term outcomes indicate that patients' fundamental preoperative desires remain consistent at the 10-year mark.
• These findings underscore the dynamic nature of patient goals in breast reconstruction and the need for ongoing assessment.