Patient-reported outcomes 3- and 18-months after mastectomy and immediate prepectoral implant-based breast reconstruction in the UK Pre-BRA prospective multicentre cohort study

Harvey, Kate L; Johnson, Leigh; Sinai, Parisa; Mills, Nicola; White, Paul; Holcombe, Christopher; Potter, Shelley; the Pre-BRA Feasibility Study Steering Group, on behalf of

Abstract

Introduction: Prepectoral techniques are becoming standard of care for implant-based breast reconstruction due to reduced impact on chest wall function and improved patient satisfaction. Evidence to support these benefits, however, is lacking. We report the patient-reported outcomes (PROs) of prepectoral breast reconstruction (PPBR) in the Pre-BRA cohort.

Methods: Women undergoing PPBR after mastectomy for breast cancer or risk-reduction between July 2019 and December 2020 were recruited. Participants completed the BREAST-Q pre-operatively and at 3 and 18-months following surgery together with a single-item evaluating overall satisfaction at 18-months. Women completing at least one BREAST-Q scale at any timepoint were eligible for inclusion. Questionnaires were scored according to the developers’ instructions and scores compared over time. Exploratory analysis, adjusting for baseline scores was performed to explore factors impacting PROs.

Results: 338/343 (98.5%) women undergoing PPBR at 40 UK centres were included in the analysis. Compared with baseline scores, women reported statistically significant and clinically meaningful decreases in both ‘Physical’ and ‘Sexual well-being’ at 3 and 18-months. Adjusting for baseline, by 18-months, those experiencing implant loss or having surgery for malignancy reported lower scores in all BREAST-Q domains. Overall, two-thirds of women (167/251) rated the outcome of their reconstruction as ‘excellent/very good’ but experiencing major complications, implant loss and being dissatisfied with wrinkling in the reconstructed breast were associated with reduced satisfaction.

Conclusions: PPBR does not result in the hypothesised improvements in PROs. These findings should be discussed with patients to support informed decision-making based on realistic expectations of outcome.

• Journal Article Type: Article
• Acceptance Date: Jan 13, 2025
• Deposit Date: Jan 14, 2025
• Journal: British Journal of Surgery
• Print ISSN: 0007-1323
• Electronic ISSN: 1365-2168
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Public URL: https://uwe-repository.worktribe.com/output/13612093