Studies Compare Flap With Implant Breast Reconstruction After Mastectomy
Breast cancer surgeons from the University of Michigan and colleagues have compared different methods of breast reconstruction used after mastectomy in 2 different studies. The studies looked at procedures that use implants and “flap” procedures. The authors conclude that women should be informed enough to make decisions along with their surgeons based on the woman’s own medical situation as well as personal preference.
In general, the studies found better quality of life and breast satisfaction with flap procedures, however, they also found that rates of complications were higher with flap procedures than with implants. The studies used data from the Mastectomy Reconstruction Outcomes Consortium (MROC) trial and were published June 20, 2018 in JAMA Surgery.
Higher personal satisfaction scores with flap procedures vs. implants
One of the studies looked at about 1200 women who completed a survey called BREAST-Q, designed to compare responses from women who had different types of breast reconstruction surgeries after mastectomies. The women took the survey before reconstruction surgery and then again 2 years after surgery.
Types of breast reconstruction
Several types of reconstruction surgery are available for women who want to rebuild their breasts after breast cancer surgery. Two main options are:
- Breast implants, which use silicone or saline inserts at the breast site
- Flap procedures, also called autologous tissue reconstruction, which use tissue from another part of a woman’s body to form a new breast
Women who underwent flap procedures reported significantly greater satisfaction with their breasts, sexual well-being, and psychosocial well-being than women who underwent implant reconstruction. However, women who underwent flap procedures reported less satisfaction with their abdomen at 2 years than they did before their surgery. Often, tissue is taken from the abdomen for a flap procedure.
More post-surgery complications with flap procedures vs. implants
The other study included more than 2300 women who underwent breast reconstruction following mastectomy and followed them for 2 years.
This study found higher complication rates within 2 years following surgery among women who underwent flap procedures compared with women who underwent implant procedures. Rates of complications ranged from 35.8% to 73.9% among the flap procedure group compared with a range of 26.6% to 31.3% among the implant group.
However, the study authors point out that with additional years of follow-up, implant-based procedures are more likely than flap procedures to have increased complication rates. Also, more surgery is often needed years later to remove, modify, or replace implants.
The study also found complication rates were higher for some women, including those who:
- Had radiation treatment during or after reconstruction
- Had chemotherapy during or after reconstruction
- Had both breasts reconstructed
- Delayed reconstruction surgery (instead of having it done at the same time as the mastectomy)
- Had higher BMI
- Were older
Authors of both studies emphasize that patients need to know about possible complications and their own risk for developing problems after reconstruction. They say the findings of these studies can be used to help women and surgeons make better informed decisions when choosing the best type of breast reconstruction procedure for their individual situation.
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Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction. Published online June 20, 2018 in JAMA Surgery. First author Katherine B. Santosa, MD. University of Michigan Health System, Ann Arbor, Mich.
Comparison of 2-Year Complication Rates Among Common Techniques for Postmastectomy Breast Reconstruction. Published online June 20, 2018 in JAMA Surgery. First author Katelyn G. Bennett, MD. University of Michigan Health System, Ann Arbor, Mich.
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