Long-term patient-reported outcomes of immediate breast reconstruction after mastectomy for breast cancer: population-based cohort study

Leigh R Johnson; Paul White; Ranjeet Jeevan; John Browne; Carmel Gulliver-Clarke; Joe O'Donoghue; Syed G Mohiuddin; William Hollingworth; Patricia Fairbrother; Mairead MacKenzie; Chris Holcombe; Shelley Potter

doi:10.1093/bjs/znad276

Long-term patient-reported outcomes of immediate breast reconstruction after mastectomy for breast cancer: population-based cohort study

Leigh R Johnson, Paul White, Ranjeet Jeevan, John Browne, Carmel Gulliver-Clarke, Joe O'Donoghue, Syed G Mohiuddin, William Hollingworth, Patricia Fairbrother, Mairead MacKenzie, Chris Holcombe, Shelley Potter^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

6 Citations (Scopus)

Abstract

Background

Breast reconstruction is offered to improve quality of life for women after mastectomy for breast cancer, but information regarding the long-term patient-reported outcomes of different reconstruction procedures is currently lacking. The Brighter study aimed to evaluate long-term patient-reported outcomes after immediate breast reconstruction (IBR) in a population-based cohort.

Methods

Women who underwent mastectomy with IBR for breast cancer in England between 1 January 2008 and 31 March 2009 were identified from National Health Service Hospital Episode Statistics. Surviving women were invited to complete the BREAST-Q, EQ-5D-5L™, and ICECAP-A at least 12 years after the index procedure. Questionnaires were scored according to developers’ instructions and compared by IBR type.

Results

Some 1236 women underwent IBR; 343 (27.8 per cent) had 2-stage expander/implant, 630 (51.0 per cent) latissimus dorsi, and 263 (21.3 per cent) abdominal flap reconstructions, with a mean(s.d.) follow-up of 13.3(0.5) years. Women who underwent abdominal flap reconstruction reported higher scores in all BREAST-Q domains than those who had other procedures. These differences remained statistically significant and clinically meaningful after adjusting for age, ethnicity, geographical region, socioeconomic status, smoking, BMI, and complications. The greatest difference was seen in scores for satisfaction with breasts; women who had abdominal flap reconstructions reported scores that were 13.17 (95 per cent c.i. 9.48 to 16.87) points; P < 0.001) higher than those among women who had two-stage expander/implant procedures. Women who underwent latissimus dorsi reconstruction reported significantly more pain/discomfort on the EQ-5D-5L™, but no other differences between procedures were seen.

Conclusion

Long-term patient-reported outcomes are significantly better following abdominal flap reconstruction than other traditional procedure types. These findings should be shared with women considering IBR to help them make informed decisions about their surgical options.

Original language	English
Article number	znad276
Pages (from-to)	1815-1823
Number of pages	9
Journal	British Journal of Surgery
Volume	110
Issue number	12
Early online date	27 Sept 2023
DOIs	https://doi.org/10.1093/bjs/znad276
Publication status	Published - 1 Dec 2023

Bibliographical note

Funding Information:
This work was funded by a National Institute for Health Research (NIHR) Research for Patient Benefit Programme Grant (PB-PG-0817-20020), and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol and the NIHR Applied Research Collaboration West. S.P. is an NIHR Clinician Scientist (CS-2016-16-019). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Acknowledgements

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

Keywords

breast reconstruction
patient reported ouitcomes
cohort study

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/bjs/znad276Licence: CC BY-NC

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Persistent link

6 Citations
3 Article (Academic Journal)

Impact of procedure type on revision surgery and secondary reconstruction after immediate breast reconstruction in a population-based cohort
Johnson, L. R., White, P., Holcombe, C., O'Donoghue, J., Jeevan, R., Browne, J., Fairbrother, P., MacKenzie, M., Gulliver Clarke, C., Mohiuddin, S., Hollingworth, W. & Potter, S., 31 Mar 2023, In: British Journal of Surgery. 110, 6, p. 666–675 10 p.
Research output: Contribution to journal › Article (Academic Journal) › peer-review

Open Access
2 Citations (Scopus)
Secondary healthcare costs after mastectomy and immediate breast reconstruction for women with breast cancer in England: population-based cohort study
Mohiuddin, S. G., Hollingworth, W., Glynn, J., Jones, T., Johnson, L. R., Potter, S. & The Brighter Steering Group, 1 Sept 2023, In: British Journal of Surgery. 110, 9, p. 1171-1179 9 p., znad149.
Research output: Contribution to journal › Article (Academic Journal) › peer-review

Open Access
1 Citation (Scopus)
Protocol for a national cohort study to explore the long-term clinical and patient-reported outcomes and cost-effectiveness of implant-based and autologous breast reconstruction after mastectomy for breast cancer: The Brighter Study
Johnson, L. R., Holcombe, C., O'Donoghue, J., Jeevan, R., Browne, J., Fairbrother, P., MacKenzie, M., Gulliver-Clarke, C., White, P., Mohiuddin, S. G., Hollingworth, W. & Potter, S., 18 Aug 2021, (E-pub ahead of print) In: BMJ Open. 11, e054055.
Research output: Contribution to journal › Article (Academic Journal) › peer-review

Open Access
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8 Citations (Scopus)

51 Downloads (Pure)

1 Finished

Full Application: The BRIghteR study Breast Reconstruction: InvestigatinG long-term clinical and cost-effectiveness in tHe National MasTectomy and BrEast Reconstruction Audit cohort
Potter, S. (Principal Investigator)
1/04/19 → 23/06/22
Project: Research

Cite this

Johnson, L. R., White, P., Jeevan, R., Browne, J., Gulliver-Clarke, C., O'Donoghue, J., Mohiuddin, S. G., Hollingworth, W., Fairbrother, P., MacKenzie, M., Holcombe, C., & Potter, S. (2023). Long-term patient-reported outcomes of immediate breast reconstruction after mastectomy for breast cancer: population-based cohort study. British Journal of Surgery, 110(12), 1815-1823. Article znad276. https://doi.org/10.1093/bjs/znad276

@article{c9acd71439af410f8f2e4cc079eebc0d,

title = "Long-term patient-reported outcomes of immediate breast reconstruction after mastectomy for breast cancer: population-based cohort study",

abstract = "BackgroundBreast reconstruction is offered to improve quality of life for women after mastectomy for breast cancer, but information regarding the long-term patient-reported outcomes of different reconstruction procedures is currently lacking. The Brighter study aimed to evaluate long-term patient-reported outcomes after immediate breast reconstruction (IBR) in a population-based cohort.MethodsWomen who underwent mastectomy with IBR for breast cancer in England between 1 January 2008 and 31 March 2009 were identified from National Health Service Hospital Episode Statistics. Surviving women were invited to complete the BREAST-Q, EQ-5D-5L{\texttrademark}, and ICECAP-A at least 12 years after the index procedure. Questionnaires were scored according to developers{\textquoteright} instructions and compared by IBR type.ResultsSome 1236 women underwent IBR; 343 (27.8 per cent) had 2-stage expander/implant, 630 (51.0 per cent) latissimus dorsi, and 263 (21.3 per cent) abdominal flap reconstructions, with a mean(s.d.) follow-up of 13.3(0.5) years. Women who underwent abdominal flap reconstruction reported higher scores in all BREAST-Q domains than those who had other procedures. These differences remained statistically significant and clinically meaningful after adjusting for age, ethnicity, geographical region, socioeconomic status, smoking, BMI, and complications. The greatest difference was seen in scores for satisfaction with breasts; women who had abdominal flap reconstructions reported scores that were 13.17 (95 per cent c.i. 9.48 to 16.87) points; P < 0.001) higher than those among women who had two-stage expander/implant procedures. Women who underwent latissimus dorsi reconstruction reported significantly more pain/discomfort on the EQ-5D-5L{\texttrademark}, but no other differences between procedures were seen.ConclusionLong-term patient-reported outcomes are significantly better following abdominal flap reconstruction than other traditional procedure types. These findings should be shared with women considering IBR to help them make informed decisions about their surgical options.",

keywords = "breast reconstruction, patient reported ouitcomes, cohort study",

author = "Johnson, {Leigh R} and Paul White and Ranjeet Jeevan and John Browne and Carmel Gulliver-Clarke and Joe O'Donoghue and Mohiuddin, {Syed G} and William Hollingworth and Patricia Fairbrother and Mairead MacKenzie and Chris Holcombe and Shelley Potter",

note = "Funding Information: This work was funded by a National Institute for Health Research (NIHR) Research for Patient Benefit Programme Grant (PB-PG-0817-20020), and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol and the NIHR Applied Research Collaboration West. S.P. is an NIHR Clinician Scientist (CS-2016-16-019). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Acknowledgements Publisher Copyright: {\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.",

year = "2023",

month = dec,

day = "1",

doi = "10.1093/bjs/znad276",

language = "English",

volume = "110",

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journal = "British Journal of Surgery",

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Johnson, LR, White, P, Jeevan, R, Browne, J, Gulliver-Clarke, C, O'Donoghue, J, Mohiuddin, SG, Hollingworth, W, Fairbrother, P, MacKenzie, M, Holcombe, C & Potter, S 2023, 'Long-term patient-reported outcomes of immediate breast reconstruction after mastectomy for breast cancer: population-based cohort study', British Journal of Surgery, vol. 110, no. 12, znad276, pp. 1815-1823. https://doi.org/10.1093/bjs/znad276

TY - JOUR

T1 - Long-term patient-reported outcomes of immediate breast reconstruction after mastectomy for breast cancer

T2 - population-based cohort study

AU - Johnson, Leigh R

AU - White, Paul

AU - Jeevan, Ranjeet

AU - Browne, John

AU - Gulliver-Clarke, Carmel

AU - O'Donoghue, Joe

AU - Mohiuddin, Syed G

AU - Hollingworth, William

AU - Fairbrother, Patricia

AU - MacKenzie, Mairead

AU - Holcombe, Chris

AU - Potter, Shelley

N1 - Funding Information: This work was funded by a National Institute for Health Research (NIHR) Research for Patient Benefit Programme Grant (PB-PG-0817-20020), and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol and the NIHR Applied Research Collaboration West. S.P. is an NIHR Clinician Scientist (CS-2016-16-019). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Acknowledgements Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

PY - 2023/12/1

Y1 - 2023/12/1

N2 - BackgroundBreast reconstruction is offered to improve quality of life for women after mastectomy for breast cancer, but information regarding the long-term patient-reported outcomes of different reconstruction procedures is currently lacking. The Brighter study aimed to evaluate long-term patient-reported outcomes after immediate breast reconstruction (IBR) in a population-based cohort.MethodsWomen who underwent mastectomy with IBR for breast cancer in England between 1 January 2008 and 31 March 2009 were identified from National Health Service Hospital Episode Statistics. Surviving women were invited to complete the BREAST-Q, EQ-5D-5L™, and ICECAP-A at least 12 years after the index procedure. Questionnaires were scored according to developers’ instructions and compared by IBR type.ResultsSome 1236 women underwent IBR; 343 (27.8 per cent) had 2-stage expander/implant, 630 (51.0 per cent) latissimus dorsi, and 263 (21.3 per cent) abdominal flap reconstructions, with a mean(s.d.) follow-up of 13.3(0.5) years. Women who underwent abdominal flap reconstruction reported higher scores in all BREAST-Q domains than those who had other procedures. These differences remained statistically significant and clinically meaningful after adjusting for age, ethnicity, geographical region, socioeconomic status, smoking, BMI, and complications. The greatest difference was seen in scores for satisfaction with breasts; women who had abdominal flap reconstructions reported scores that were 13.17 (95 per cent c.i. 9.48 to 16.87) points; P < 0.001) higher than those among women who had two-stage expander/implant procedures. Women who underwent latissimus dorsi reconstruction reported significantly more pain/discomfort on the EQ-5D-5L™, but no other differences between procedures were seen.ConclusionLong-term patient-reported outcomes are significantly better following abdominal flap reconstruction than other traditional procedure types. These findings should be shared with women considering IBR to help them make informed decisions about their surgical options.

AB - BackgroundBreast reconstruction is offered to improve quality of life for women after mastectomy for breast cancer, but information regarding the long-term patient-reported outcomes of different reconstruction procedures is currently lacking. The Brighter study aimed to evaluate long-term patient-reported outcomes after immediate breast reconstruction (IBR) in a population-based cohort.MethodsWomen who underwent mastectomy with IBR for breast cancer in England between 1 January 2008 and 31 March 2009 were identified from National Health Service Hospital Episode Statistics. Surviving women were invited to complete the BREAST-Q, EQ-5D-5L™, and ICECAP-A at least 12 years after the index procedure. Questionnaires were scored according to developers’ instructions and compared by IBR type.ResultsSome 1236 women underwent IBR; 343 (27.8 per cent) had 2-stage expander/implant, 630 (51.0 per cent) latissimus dorsi, and 263 (21.3 per cent) abdominal flap reconstructions, with a mean(s.d.) follow-up of 13.3(0.5) years. Women who underwent abdominal flap reconstruction reported higher scores in all BREAST-Q domains than those who had other procedures. These differences remained statistically significant and clinically meaningful after adjusting for age, ethnicity, geographical region, socioeconomic status, smoking, BMI, and complications. The greatest difference was seen in scores for satisfaction with breasts; women who had abdominal flap reconstructions reported scores that were 13.17 (95 per cent c.i. 9.48 to 16.87) points; P < 0.001) higher than those among women who had two-stage expander/implant procedures. Women who underwent latissimus dorsi reconstruction reported significantly more pain/discomfort on the EQ-5D-5L™, but no other differences between procedures were seen.ConclusionLong-term patient-reported outcomes are significantly better following abdominal flap reconstruction than other traditional procedure types. These findings should be shared with women considering IBR to help them make informed decisions about their surgical options.

KW - breast reconstruction

KW - patient reported ouitcomes

KW - cohort study

U2 - 10.1093/bjs/znad276

DO - 10.1093/bjs/znad276

M3 - Article (Academic Journal)

C2 - 37766501

SN - 0007-1323

VL - 110

SP - 1815

EP - 1823

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 12

M1 - znad276

ER -

Long-term patient-reported outcomes of immediate breast reconstruction after mastectomy for breast cancer: population-based cohort study

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Handle.net

Fingerprint

Research output

Impact of procedure type on revision surgery and secondary reconstruction after immediate breast reconstruction in a population-based cohort

Secondary healthcare costs after mastectomy and immediate breast reconstruction for women with breast cancer in England: population-based cohort study

Protocol for a national cohort study to explore the long-term clinical and patient-reported outcomes and cost-effectiveness of implant-based and autologous breast reconstruction after mastectomy for breast cancer: The Brighter Study

Projects

Full Application: The BRIghteR study Breast Reconstruction: InvestigatinG long-term clinical and cost-effectiveness in tHe National MasTectomy and BrEast Reconstruction Audit cohort

Cite this

Protocol for a national cohort study to explore the long-term clinical and patient-reported outcomes and cost-effectiveness of implant-based and autologous breast reconstruction after mastectomy for breast cancer: The Brighter Study