Garment-related patient-reported outcomes: comparison of autologous and implant-based breast reconstruction

Introduction: Clothing worn on breasts, especially bras, has a tremendous impact on a person’s appearance and comfort, and consequently, their thoughts and feelings about their body. Previously, we used focus groups to explore breast cancer survivors’ experiences with bras over time to identify preferences, needs, and challenges throughout their journeys. Here, we expand our needs assessment using garment-related items of the BREAST-Q, a widely used patient-reported outcome measure.

Materials and

Methods: We selected participants who underwent breast reconstruction at The University of Texas MD Anderson Cancer Center between 2011 and 2015 in an IRB-approved study. Eligible participants had two native breasts before surgery, at least 42 days after the autologous tissue transfer procedure or at least 90 days after the implant-based reconstruction. Participants completed the BREAST-Q pre mastectomy and post reconstruction. We analyzed participants’ responses to the garment-related measures: “being able to wear clothing that is more fitted” (rated from 1 to 4), “how comfortably your bras fit” (rated from 1 to 4), “how you look in the mirror clothed” (rated from 1 to 4), “feminine in your clothes” (rated from 1 to 5), and “sexually attractive in your clothes” (rated from 1 to 5), where higher scores indicated greater satisfaction. The paired t-test or Wilcoxon signed-rank test was used to compare pre-post changes within a surgery type. depending on the normality of the data. Normality was assessed using the Shapiro-Wilk test. The Mann-Whitney U test was used to compare the mean pre-post difference between surgery types.

Results, Conclusions, and Discussions: Among 81 participants, 27 had autologous reconstruction (age range 32-72, mean age 52.3 years), and 54 had implant-based reconstruction (age range 28-69, mean age 45.8). 56 out of 81 participants underwent bilateral reconstruction, and the rest underwent unilateral reconstruction. 86.4 percent of participants did not undergo radiation, 2.4 percent did, and the rest were not reported. Both autologous and implant-based reconstruction patients had statistically significant pre-post changes in garment related BREAST-Q measures, with the exception of “how comfortably your bras fit” for implant-based reconstruction. All the pre-post changes were in positive direction (Figure 1). The magnitude of pre-post changes among patients who underwent autologous reconstruction was higher than those who underwent implant-based reconstruction, with “sexually attractive in your clothes” showing a statistically significant higher degree of improvement for participants who underwent autologous reconstruction compared to implant-based reconstruction. This suggests that autologous reconstruction can improve garment experiences to a greater extent than does implant-based reconstruction. Regarding “how comfortably your bras fit”, patients who underwent autologous reconstruction reported a statistically significant increase, while those with implant-based reconstruction did not. A plausible explanation for this difference is that autologous tissue is easier to deform to the bra cup shape, unlike an implant, which is more rigid.

Previous focus group studies suggest that patients who undergo either implant-based or autologous reconstruction often find it challenging to locate a fitted, comfortable, aesthetically appealing bra that suits them after surgery. In contrast, this needs assessment using garment-related items of the BREAST-Q found that patients who underwent autologous reconstruction reported improved bra fit relative to their pre-mastectomy experiences whereas there was no statistically significant change for patients who underwent implant-based reconstruction. Moreover, the garment-related items of the BREAST-Q that considered garment experiences more broadly, e.g., being able to wear clothing that is more fitted, demonstrated post-reconstruction gains for both autologous and implant-based reconstructions.

Acknowledgements (Optional): This study was supported by NIH grant R01 CA 203984.