152c: Immediate Partial Breast Reconstruction Following Lumpectomy or Partial Mastectomy Using Acellular Dermal Matrix (Alloderm): Outcomes Study Initial Experience

Abstract

Purpose:The overriding goal of post-mastectomy breast reconstruction is to restore body image and satisfy patient expectations. Measuring individual patient expectations would allow surgeons to identify patients who have unrealistic expectations, and subsequently to address their issues preoperatively through focused pre-surgical education. The purpose of our study is to develop a questionnaire to measure individual patient expectations for breast reconstruction.Methods: Interviews were conducted with 44 women undergoing breast reconstruction. The interviews were recorded, transcribed, and analyzed thematically. Conceptual domains were used to organize statements into a preliminary version of the questionnaire. The preliminary version was then pilot tested with 30 women undergoing breast reconstruction, and was reviewed by an expert panel, to create the field test version. The field test version was then administered to 150 women prior to undergoing breast reconstruction.Results: Patient interviews revealed that expectations for breast reconstruction fall into four main domains: Breast Appearance and Outcome, Physical Well-being, Psychosocial Well-being, and Process of Care. These domains formed the organizational structure for the questionnaire. Pilot testing resulted in minor wording changes, clarified ambiguities, and recognized missing content. Using field test data, item reduction was performed to create the final scales.Conclusions: Patient expectations for the results of breast reconstruction are complex, and encompass not only breast appearance, but physical well-being, psychological wellbeing, and process of care. This study is essential in the quest to improve patient satisfaction with the results of breast reconstruction. A formalized appreciation of expectations will initiate further research into the link between expectations, satisfaction and quality of life for breast cancer survivors. The questionnaire will provide surgeons and patients with a valid tool to guide discussions about expectations.Background: Current options for immediate breast reconstruction following partial mastectomy or lumpectomy include latissimus dorsi myocutaneous flap and simple closure among others. Latissimus dorsi flap reconstruction is currently the most widely accepted option, however it can be associated with significant complications. Acellular dermal matrix has been used to improve cosmetic results of various flap reconstructions. One type of cadaveric dermal matrix is AlloDerm (Lifecell, NJ). To date, no studies have evaluated the use of AlloDerm as filler for breast defects using patient satisfaction surveys for qualitative outcomes. Our goal is to determine whether the use of acellular dermal matrix in lumpectomy or partial breast reconstruction produces satisfactory results compared to current reconstructive options. We also aim to establish a quantitative and qualitative scale for evaluation. Finally, we will evaluate whether post reconstruction radiation affects outcomes when using AlloDerm. Methods:Retrospecti...