TY - JOUR
T1 - Aesthetic Evaluation of Breast Reconstruction with Autologous Fat Transfer vs. Implants
AU - Wederfoort, Jamilla L M
AU - Kleeven, Alieske
AU - Hommes, Juliette E
AU - Van Kuijk, Sander M J
AU - van der Hulst, René R W J
AU - Piatkowski, Andrzej
AU - M.D for The Breast trial investigators
N1 - Funding Information:
The BREAST trial was funded by ZonMw; The Netherlands Organisation for Health Research and Development (Grant Number 80-83700-98-15505).
Funding Information:
We would like to thank all participants of the BREAST trial, breast cancer evaluators, plastic surgeons of the MUMC+, Breast Cancer Association of the Netherlands (BVN), all laymen, investigators, patient advisors, and institutions involved in this study, such as the Dutch Health Institute and Health Insurance Alliance Netherlands. Andrzej Piatkowski1,2,3, Jamilla L. M. Wederfoort1,2, Juliette E. Hommes1,2, Sander J. Schop1,2, Todor K. Krastev1, Sander M. J. van Kuijk4, René R. W. J. van der Hulst1,2, Daniëlle Derks5, Mikko Larsen6, Hinne Rakhorst7, Ute Schmidbauer7, Jan Maerten Smit8, Liang T. Tan9, Kim M. E. Wehrens9, Thijs de Wit101Department of Plastic-, Reconstructive-, and Hand Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.2NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.3Department of Plastic-, Reconstructive-, and Hand Surgery, Viecuri Medical Center, Venlo, The Netherlands.4Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands.5Plastic, Reconstructive, and Hand Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands.6Plastic, Reconstructive, and Hand Surgery, Launceston General Hospital, Launceston, TAS, Australia.7Department of Plastic Surgery, Hospital Group Twente (ZGT), Twente, The Netherlands.8Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands.9Plastic, Reconstructive, and Hand Surgery, Haaglanden Medical Center The Hague, The Netherlands.10Plastic, Reconstructive, and Hand Surgery, Amphia Hospital, Breda, The Netherlands
Publisher Copyright:
© 2022, The Author(s).
PY - 2023/4
Y1 - 2023/4
N2 - Background: Autologous fat transfer (AFT) seems to be a new minimal invasive method for total breast reconstruction, yet how patients, surgeons, and laymen evaluate cosmesis is lacking. The aim of this study was to evaluate the aesthetic outcome of AFT (intervention group) for total breast reconstruction post-mastectomy, as compared to implant-based reconstruction (IBR) (control group). Methods: A random and blinded 3D photographic aesthetic outcome study was performed on a selection of 50 patients, scored by three panels: plastic surgeons, breast cancer patients, and laymen. Secondary outcomes included agreement within groups and possible patient characteristics influencing scoring. Results: Breast cancer patients and plastic surgeons did not differ in the aesthetic scores between the treatment groups. In contrast, the laymen group scored AFT patients lower than IBR patients (− 1.04, p < 0.001). Remarkably, mean given scores were low for all groups and overall agreement within groups was poor (ICC < 0.50). Higher scores were given when subjects underwent a bilateral reconstruction and if a mamilla was present. Conclusion: Evaluation of aesthetic outcomes varies greatly. Hence, aesthetic outcome remains a very personal measure and this emphasizes the importance of thorough patient counseling including information on achievable aesthetic results before starting a reconstructive procedure. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
AB - Background: Autologous fat transfer (AFT) seems to be a new minimal invasive method for total breast reconstruction, yet how patients, surgeons, and laymen evaluate cosmesis is lacking. The aim of this study was to evaluate the aesthetic outcome of AFT (intervention group) for total breast reconstruction post-mastectomy, as compared to implant-based reconstruction (IBR) (control group). Methods: A random and blinded 3D photographic aesthetic outcome study was performed on a selection of 50 patients, scored by three panels: plastic surgeons, breast cancer patients, and laymen. Secondary outcomes included agreement within groups and possible patient characteristics influencing scoring. Results: Breast cancer patients and plastic surgeons did not differ in the aesthetic scores between the treatment groups. In contrast, the laymen group scored AFT patients lower than IBR patients (− 1.04, p < 0.001). Remarkably, mean given scores were low for all groups and overall agreement within groups was poor (ICC < 0.50). Higher scores were given when subjects underwent a bilateral reconstruction and if a mamilla was present. Conclusion: Evaluation of aesthetic outcomes varies greatly. Hence, aesthetic outcome remains a very personal measure and this emphasizes the importance of thorough patient counseling including information on achievable aesthetic results before starting a reconstructive procedure. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
U2 - 10.1007/s00266-022-03076-2
DO - 10.1007/s00266-022-03076-2
M3 - Article
C2 - 36100783
SN - 0364-216X
VL - 47
SP - 593
EP - 604
JO - Aesthetic Plastic Surgery
JF - Aesthetic Plastic Surgery
IS - 2
ER -