Assessing Patient Priorities and Satisfaction Regarding Aesthetic Outcomes Following Autologous Breast Reconstruction

Breast reconstruction aims to enhance patient quality of life by achieving optimal aesthetic outcomes. This study examines aesthetic preferences and satisfaction among patients undergoing autologous breast reconstruction (ABR).

A 35-item survey was distributed to adult patients who underwent ABR from 2017 to 2023 at the University of Pennsylvania Health System. Patients completed three separate ranking questions in which they were asked to prioritize individual components of the breast (ranked 1-8), abdominal donor site (1-7), and nipple-areolar complex (1-6), with lower values indicating greater importance. Satisfaction was assessed using a 5-point Likert scale. Non-responders were contacted at 1 and 4 weeks, followed by phone outreach.

Among 301 eligible patients, 156 responded (52.1%). Breast symmetry was the highest priority (mean = 1.9, SD = 1.2), followed by shape/contour (2.6, 1.4) and position (3.1, 1.6), while NAC (5.3, 1.8) and donor site aesthetics (5.7, 1.6) ranked lowest. Satisfaction was higher for breast aesthetics (66%) than for donor site aesthetics (58%). Black patients prioritized shape/contour (64%) over symmetry (10%), while White patients prioritized symmetry (51%) over shape (26%) (p < 0.05). Black patients also reported greater dissatisfaction with breast (p = 0.006) and donor site (p = 0.029) aesthetics.

This study shows that patients value different facets of their reconstruction differently. Furthermore, racial differences in aesthetic preferences and satisfaction following ABR emerged, which providers need to be mindful of. Addressing patient expectations through improved communication during the preoperative consultation may enhance aesthetic outcomes and patient satisfaction.

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