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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

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 Thumbnail


Authors

Kate L Harvey

Leigh Johnson

Parisa Sinai

Nicola Mills

Paul White Paul.White@uwe.ac.uk
Professor in Applied Statistics

Christopher Holcombe

Shelley Potter

on behalf of the Pre-BRA Feasibility Study Steering Group



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. Here, patient-reported outcomes (PROs) of prepectoral breast reconstruction (PPBR) in the Pre-BRA cohort are reported. 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 preoperatively 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 In total 338 of 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, at 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/rippling in the reconstructed breast were associated with reduced satisfaction. Conclusions PPBR impacts postoperative physical well-being and PROs are variable. These findings should be discussed with patients to support informed decision-making based on realistic expectations of outcome. Study registration ISRCTN11898000.

Journal Article Type Article
Acceptance Date Jan 13, 2025
Online Publication Date Feb 25, 2025
Publication Date Feb 28, 2025
Deposit Date Jan 14, 2025
Publicly Available Date Mar 12, 2025
Journal British Journal of Surgery
Print ISSN 0007-1323
Electronic ISSN 1365-2168
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 112
Issue 2
DOI https://doi.org/10.1093/bjs/znaf032
Public URL https://uwe-repository.worktribe.com/output/13612093

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