After mastectomy: Large study follows reconstruction patients for info on outcomes

For women facing a mastectomy, information is the power to choose what is best for their health, well-being and quality of life.

A June study sponsored by the University of Michigan from a multicenter research consortium aims to help breast cancer patients make decisions about breast reconstruction while armed with the facts about the risks and rewards associated with different surgical options. The study, published in JAMA Surgery, followed 2,300 women who had breast reconstruction surgery and tracked their outcomes for two or more years to compare the most commonly used techniques, risks and complications for reconstruction.

Breast reconstruction after a mastectomy is associated with significant quality of life benefits. However, like all health-care interventions it has pros and cons, said Dr. Edwin Wilkins, professor and researcher at Michigan Medicine who was involved in the study.

There is no right answer to which is the best type of breast reconstruction surgery, said Dr. Andrea Pusic, chief of plastic surgery and reconstructive surgery at Brigham and Women’s Hospital in Boston.

“There is no single story,” Pusic said. The goal is to help women understand the pros and cons, to know they have choices and to recognize their options, she said.

Options and outcomes
About 40 percent of women who undergo a mastectomy have breast reconstruction surgery, according to 2014 data released last year by the federal Agency for Healthcare Research and Quality.

The two main options for breast reconstruction are artificial implants filled with saline or silicone gel and flap surgery, also called autologous reconstruction, which uses a woman’s own tissue often from the abdomen. Both have risks and benefits.

Breast reconstruction can be done immediately after mastectomy surgery or later as a second surgery depending on an individual’s preference and needs.

“Complications do happen. Close to 1 in 3 women has some sort of post-surgical complication,” Pusic said. Some were minor “bumps in the road” such as a wound infection; others were more severe and required a secondary surgery, Pusic said.

A 33 percent complication risk does sound high, but the complication rate for mastectomy alone is 20 percent, Wilkins said.

While complications are common, failure is not, Wilkins said.

“The risk of failure is extremely low,” Pusic said.

Myriad choices
The Mastectomy Reconstruction Outcomes Consortium study provides women with valuable yet complicated and contradictory information, Wilkins said. There are trade-offs to whatever option a woman chooses.
For example, women who had flap (natural tissue) reconstruction were twice as likely to experience some sort of complication within two years, but the failure rate was among the lowest, Wilkins said. Women who made this choice were significantly more satisfied with their breasts and breast-related quality of life two or more years after surgery than those who had implants. Some of these women reported feeling even more satisfied than their pre-surgery baselines, but others said tightness and pain in the abdominal wall persisted for years after surgery.

Breast reconstruction surgery has come a long way, Pusic said. In the past surgeons needed to take away more muscle, but now the standard is to disturb less for better outcomes.

There are at least six distinctly different breast reconstruction options, Wilkins said, and “there’s no one best option.” Giving women the information empowers them to work with their doctors to make good decisions, Wilkins said.