Patient-reported Outcome Measures with Chest Wall Perforator Flap Reconstruction: The Northern Health Experience

Background: The use of chest wall perforator flaps (CWPF) in breast conserving cancer surgery (BCS) has revolutionized volume replacement techniques, providing low-morbidity, like-for-like tissue replacement whilst maintaining breast volume. Soft tissue flaps based on AICAP and LICAP (anterior/lateral intercostal artery perforator) are popular options, with extensive clinical research demonstrating oncological safety, robust reconstruction and good cosmesis. This study explores the patient perspective following breast conservation surgery with chest wall perforator flap reconstruction in our centre in Melbourne, Australia. Methods: Patients receiving BCS with CWPF reconstruction over 24 months were recruited to the study. We performed an online questionnaire survey based on the BREAST-Q (ver 2.0, MSKCC), breast conserving therapy and reconstruction modules. Patients undergoing CWPF reconstruction completed pre- and post-operative questionnaires. Comparisons were made using the Student's T test. Results: Early data suggests that patients were happy with their cosmetic outcome, with satisfactory maintenance of symmetry and minimal visible scarring. Results reveal high satisfaction ratings over a range of scales, including psychosocial, self-esteem, cancer worry, and satisfaction with breast cosmesis. Postoperative sensory reduction and skin induration was commonly reported, but this did not correlate with reduced psychosocial wellbeing or quality of life. Conclusion: This qualitative study provides valuable insights into the subjective experience and perspective of breast cancer patients. The research contributes to the growing body of knowledge on breast cancer reconstruction by exploring patient perspectives on cosmetic outcome after LICAP/AICAP flap. By incorporating patient voices, this project aims to enhance the decision-making process and improve the overall quality of care for patients who elect for CWPF reconstruction. References: 1. Char S, Bloom JA, Erlichman Z, Jonczyk MM, Chatterjee A. A comprehensive literature review of patient-reported outcome measures (PROMs) among common breast reconstruction options: What types of breast reconstruction score well? Breast J. 2021 Apr;27(4):322-329. doi: 10.1111/tbj.14186. Epub 2021 Feb 9. PMID: 33565192.