SCARS MAY INDEED “HAVE THE STRANGE POWER TO REMIND US THAT OUR PAST IS REAL”:* A PATIENT REPORTED OUTCOME MEASURES STUDY IN WOMEN WITH POSTMASTECTOMY BREAST RECONSTRUCTION

Öz

Objective: One of the leading causes of death among women is breast cancer. The disease process and treatment journey consume patients’ emotional and physical energy, severely affecting mood, self-esteem, body image, sexual functions, commitment, and overall quality of life. Postmastectomy breast reconstruction is known to revert some of these adversarial conditions. This study uses patient-reported outcome measures (PROMs) to investigate the factors influencing the end result and quality of life regarding postmastectomy breast reconstruction. Material and Method: Thirty-four patients who’d undergone breast reconstruction filled out a questionnaire form including 54 questions pertaining the patients’ surgical and oncological history, demographics, mood, self-esteem, body and breast self-image, social and familial support mechanisms, and satisfaction with life and reconstruction. The study then collected anthropometric measurements and standardized photographs and had plastic surgery residents assess aesthetic outcome with regard to the photographs. Result: Half of the patients had immediate while the other half had delayed reconstruction. Of the patients, 10 (29.4%) had reconstructions that only involved an implant, 15 (44.1%) had reconstructions that only involved autogenous tissue, and nine (26.5%) that had both. No significant association could be found for the reconstruction method or timing of the reconstruction with aesthetic results, symmetry, or patient satisfaction. Meanwhile, nipple-areolar complex (NAC) reconstruction contributed to significantly better aesthetic outcomes (p=0.026) and overall patient satisfaction (p=0.029). Scar issues were found to significantly affect satisfaction scores (p=0.008) while not affecting the aesthetic outcome. Conclusion: Neither symmetry nor aesthetic outcome were found to be major factors influencing patients’ overall satisfaction with breast reconstruction. However, scars are relevant as constant reminders of past surgeries. Another significant factor in patient satisfaction was NAC reconstruction.

Anahtar Kelimeler

• Breast
• reconstruction
• cancer
• mastectomy
• scars
• nipple

İZLERİN GERÇEKTEN DE ‘ENTERESAN BİR ŞEKİLDE YAŞADIKLARIMIZIN GERÇEK OLDUĞUNU BİZE ANIMSATMA GÜCÜ’* OLABİLİR: MASTEKTOMİ SONRASI MEME REKONSTRÜKSİYONU YAPILMIŞ KADINLARDA HASTA RAPORLU BİR SONUÇ ÇALIŞMASI

Öz

Amaç: Meme kanseri kadınlar arasında önde gelen ölüm nedenlerinden biridir. Hastalığın seyri ve tedavisi hastaların duygusal ve fiziksel enerjisini tüketir ve duygu-durumları, özgüvenlerini, cinsel işlevlerini, yaşama bağlılık ve yaşam kalitelerini etkiler. Mastektomi sonrası meme rekonstrüksiyonu ise bu sorunların bir kısmının giderilmesinde yardımcı olabilir. Bu hasta tarafından raporlanan çıktı ölçütleri çalışmasında sonuçları ve hastaların yaşam kalitelerini etkileyen etmenler araştırılmıştır. Gereç ve Yöntem: Meme rekonstrüksiyonu geçirmiş toplam 34 hasta cerrahi ve onkolojik öyküleri, demografik verileri, duygu-durumları, beden ve meme öz algıları, sosyal ve ailesel destek mekanizmaları ile yaşam ve rekonstrüksiyondan memnuniyetlerini sorgulayan 54 soruluk bir anket yanıtladı. Sonrasında antropometrik ölçümler ve standardize fotoğraflar alındı. Estetik sonuçları bu fotoğrafların üzerinden değerlendirildi. Bulgular: Hastaların yarısına eş zamanlı, yarısına geç dönemde rekonstrüksiyon yapılmıştı. On hastaya (%29,4) sadece implant ile, 15’ine (%44,1) sadece otojen doku ile ve dokuzuna (%26,5) ikisi de yapılmıştı. Rekonstrüksiyon metodu veya zamanlamasının estetik sonuçlar, simetri veya hasta memnuniyetiyle aralarında anlamlı bir ilişki bulunamadı. Bununla beraber meme başı-areola kompleksi (MAK) rekonstrüksiyonu yapılmış olması hem estetik sonuçları (p=0,026), hem de hasta memnuniyetini (p=0,029) anlamlı derecede olumlu yönde etkilemişti. Donör morbiditeleri estetik sonuçlar ve hasta memnuniyeti üzerinde anlamlı bir olumsuz etki oluşturmamıştı. Ancak nedbe sorunları estetik sonuçları anlamlı derecede etkilemezken hasta memnuniyetini olumsuz yönde etkileyen tek etmen olarak ortaya çıkmıştır (p=0,008). Sonuç: Meme rekonstrüksiyonunda memnuniyeti anlamlı ölçüde etkileyen etmenler arasında simetri ve estetik sonuç bulunmazken süreci kendilerine anımsatan nedbe sorunları bulunmuştur. Hasta memnuniyetini anlamlı derecede etkileyen bir diğer etmen ise MAK onarımı yapılmış olmasıdır.

Anahtar Kelimeler

• Meme
• rekonstrüksiyon
• kanser
• mastektomi
• nedbe
• meme başı

Kaynakça

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