For many women facing treatment for breast cancer, breast reconstruction after mastectomy is a quality of life issue. It is linked with feeling more feminine, or "whole again" after surgery. But choosing the type of reconstruction is a complex process, and the decision can be difficult and stressful.

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A new study from a multicenter research consortium sponsored by Michigan Medicine aims to help breast cancer patients make these decisions while armed with important data about the risks and rewards associated with each surgical option. The study was published in JAMA Surgery.

"Imagine you're a woman facing a mastectomy," says study author Edwin Wilkins, M.D., professor and researcher at Michigan Medicine. "Then a plastic surgeon walks in the door and says you can have breast reconstruction, and there are six or seven different options. How do you know what to choose?"

In this study, Wilkins, along with a team of researchers from the Mastectomy Reconstruction Outcomes Consortium (MROC), followed more than 2,300 women who had breast reconstruction surgery at one of the 11 participating centers.

Complication rates and patient-reported outcomes were tracked for two or more years after the surgery to compare the commonly used techniques for breast reconstruction.

"We were particularly focused on assessing the risks and benefits from a patient's eye view," says Wilkins. The study measured a wide range of outcomes, including patient satisfaction, quality of life, body image, social functioning, physical well-being and pain. "Our ultimate goal is to empower consumers with information to work with their doctors to make decisions tailored to patients' values and preferences."

Comparing complications

Close to a third of women who had breast reconstruction had some kind of post-surgical complication. Some were as minor as a wound that took extra time to heal, requiring an antibiotic ointment. But 19 percent of patients required follow-up surgery to address a complication. And 5 percent of all patients in the study had reconstructive failure, meaning the implant or tissue had to be removed.

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The researchers found significant differences across the different reconstruction types. Generally, those who had one of several types of flap reconstruction — which uses a patient's own natural tissue, usually taken from their abdomen — had a higher risk of complications than those who had breast implants. But natural tissue reconstruction had a much lower risk of failure than breast implants.

"The message here is that these operations are not without risk," says Wilkins. "Complications are fairly common, but thankfully failure is uncommon. Based on these results, what I now tell new patients is that even with the bumps in the road, we usually get where we're going with reconstruction."

Patients who had flap, or natural tissue, reconstruction were significantly more satisfied with their breasts and breast-related quality of life two or more years after surgery than those who had implants, even showing satisfaction levels that exceeded their pre-surgery baselines. But for some women, tightness and pain in the abdominal wall persisted for years after surgery.

"The key takeaway from this research is that these are complicated decisions," says Wilkins. "As with all health care decisions, patients need up-to-date information that empowers them to actively work with their doctors to choose what's best for them."

Wilkins and his team are working with the U-M Center for Health Communications Research to use the data gathered from the MROC study to build a web-based decision-making platform. Patients will be able to enter variables — height, weight, age, whether they smoke, if they have had radiation — and will receive information tailored for them that will help guide them through the decision-making process and each step of the operation and recovery.

This study was supported by grant R01CA152192 from the National Institutes of Health National Cancer Institute.