How We Feel: Charting BREAST-Q Sensation Module Outcomes Over Time in Neurotized Autologous Reconstruction versus Two-Stage Alloplastic Reconstruction

Purpose: As the surgical community has increasingly realized the importance of patient-reported outcomes as a measure of success of a surgery, new tools have been developed to allow providers to assess patient satisfaction and psychosocial outcomes in a standardized manner. The recently-published BREAST-Q Sensation Module addresses a need to evaluate breast sensation and its impact on life in postmastectomy breast reconstruction patients. Methods: This study included 90 patients with alloplastic reconstruction and 103 patients with autologous reconstruction. Patients undergoing mastectomy and breast reconstruction were administered the Sensation Module of the BREAST-Q preoperatively and at specified postoperative timepoints. Statistical analysis was performed to compare scores of patients receiving autologous and alloplastic breast reconstruction. All autologous reconstruction was done with a neurotized deep inferior epigastric perforator flap. All alloplastic reconstruction was two-stage. Results: Breast Sensation scores are higher in the alloplastic group in the first 1-2 years after reconstruction before scores in the autologous group increase from 3 years onward. The autologous group had much higher scores for the Breast Symptoms scale than the alloplastic group, with a statistically significant difference at 2 years postoperative (91 vs. 75.5, p < 0.05). For the Quality-of-Life Impact of Sensation scale, the alloplastic group had higher scores in the first 3 years after surgery, but scores began to decline thereafter, while the autologous group had improved scores over time. Conclusions: Patients with autologous breast reconstruction experience fewer unpleasant breast symptoms than patients with alloplastic breast reconstruction. Interestingly, while patients with alloplastic reconstruction report greater breast sensation and QoL impact in the short-term, scores in patients with autologous reconstruction become equal or better in the long-term. This may be explained by the time course of reinnervation of autologous flaps. Patient selection bias may also play a role, as patients eligible for autologous reconstruction tend to have a higher BMI and larger breast surface area to reinnervate. Further study is ongoing to control these results for breast size.