Marc A.M. Mureau

Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer

The outcome of bilateral prophylactic mastectomy with breast reconstruction (BPM-IBR) in healthy BRCA1/2 mutation carriers can be potentially burdensome for body image and the intimate relationship. Therefore, in the current analysis the impact on body image, sexual and partner relationship satisfaction was prospectively investigated in women opting for BPM-IBR as well as cancer distress and general quality of life. Healthy women undergoing BPM-IBR completed questionnaires preoperatively (T0, nxa0=xa048), at 6xa0months (T1, nxa0=xa044) and after finishing breast reconstruction (median 21xa0months, range 12–35) (T2, nxa0=xa036). With multi-level regression analyses the course of outcome variables was investigated and a statistically significant change in body image and/or sexual and partner relationship satisfaction was predicted by baseline covariates. Body image significantly decreased at T1. At T2 sexual relationship satisfaction and body image tended to be lower compared to baseline. The overall partner relationship satisfaction did not significantly change. At T2, 37xa0% of the women reported that their breasts felt unpleasantly, 29xa0% was not satisfied with their breast appearance and 21xa0% felt embarrassed for their naked body. Most body image issues remained unchanged in 30xa0% of the women. A negative body image was predicted by high preoperative cancer distress. BPM-IBR was associated with adverse impact on body image in a substantial subgroup, but satisfaction with the overall sexual and partner relationship did not significantly change in time. The psychosocial impact of BPM-IBR in unaffected women should not be underestimated. Psychological support should ideally be integrated both before and after BPM-IBR.

High satisfaction rates in women after DIEP flap breast reconstruction.

BACKGROUNDnBreast reconstruction (BR) is aimed at improving quality of life (QoL) after mastectomy. Patient satisfaction is an important indicator to evaluate the success of BR. This study explored patient satisfaction and its determinants in women undergoing deep inferior epigastric artery perforator (DIEP) flap BR as well as the impact of the procedure on body image, sexuality and QoL.nnnMETHODSnPatient satisfaction and QoL were studied in 72 women who underwent DIEP flap BR using a study-specific questionnaire as well as the Short Form-36 (SF-36).nnnRESULTSnPatient satisfaction was very high. Approximately 90% of the patients reported that they had been sufficiently informed about the procedure and its consequences, that their preoperative expectations had been met, that the reconstructed breast felt like their own and that they would choose the same procedure again and would recommend this procedure to a friend. Patient satisfaction was positively and significantly related to the reconstructed breast(s) feeling like their own. Women with secondary reconstructions were more positive about changes in sexuality and femininity than women with primary BRs. There were no clinically relevant differences in QoL between our study population and a random sample of Dutch females.nnnCONCLUSIONSnWomen with DIEP flap BRs reported high satisfaction rates. However, to compare these satisfaction rates with other forms of BR, prospective studies in comparable groups are necessary.

Women's motives to opt for either implant or DIEP-flap breast reconstruction.

OBJECTIVEnUnderstanding womens motives concerning breast reconstructive surgery will contribute to a better counselling and care for the increasing number of women choosing post-mastectomy breast reconstruction (BR).nnnMETHODSnWe interviewed 31 women who opted for implant or deep inferior epigastric perforator (DIEP)-flap BR after therapeutic or prophylactic mastectomy. Motives for BR in general and for the selected type of BR were investigated following a phenomenological qualitative research approach.nnnRESULTSnWomen opting for implant BR were concerned with surgery-related issues, such as recovery time, number of scars and impact of surgery. They wanted to return to their daily life and restore their body image as soon as possible. Patients choosing DIEP-flap BR were more focussed on regaining a natural breast and wanted to benefit from the advantages of autologous tissue. Women scheduled for prophylactic mastectomy saw BR as an integral part of their treatment. Patients opting for BR after therapeutic mastectomy wanted to regain a complete body image with BR.nnnCONCLUSIONSnPatients motives for implant BR were primarily related to surgical issues, whereas women who chose DIEP-flap BR especially focussed on regaining a breast that resembles their own lost breast as well as possible. Clinical variables (such as therapeutic or prophylactic mastectomy, breast irradiation, and waiting lists) need to be taken into account when considering a certain type of BR, as these can be of great importance in the decision-making process.

The short-term psychological impact of complications after breast reconstruction.

Few studies have focused on the psychological impact of postoperative complications after breast reconstruction (BR). As postoperative complications after BR usually lead to a prolonged recovery time and sometimes require additional surgery, the short‐term impact on distress was investigated.

Impact of delayed implant and DIEP flap breast reconstruction on body image and sexual satisfaction: a prospective follow-up study.

Prospective studies regarding the psychosexual impact after different types of breast reconstruction (BR) are scarce. The impact of either implant or deep inferior epigastric artery perforator (DIEP) flap BR on body image and sexual relationship satisfaction was investigated in time.

Maximizing results in reconstruction of cheek defects.

The face is exceedingly important, as it is the medium through which individuals interact with the rest of society. Reconstruction of cheek defects after trauma or surgery is a continuing challenge for surgeons who wish to reliably restore facial function and appearance. Important in aesthetic facial reconstruction are the aesthetic unit principles, by which the face can be divided in central facial units (nose, lips, eyelids) and peripheral facial units (cheeks, forehead, chin). This article summarizes established options for reconstruction of cheek defects and provides an overview of several modifications as well as tips and tricks to avoid complications and maximize aesthetic results.

The impact of nasal reconstruction following tumour resection on psychosocial functioning, a clinical‐empirical exploration

Objective: Total or partial nasal amputation following tumour resection is one of the more severe facial disfigurements. Successful nasal reconstruction can therefore be regarded as restoring a patients psychosocial health. The objective of this study, therefore, was to evaluate different determinants of patients psychosocial functioning and their effect on patient satisfaction after nasal reconstruction.

Information-seeking behaviour and coping style of women opting for either implant or DIEP-flap breast reconstruction

BACKGROUNDnHigh satisfaction rates have been reported after autologous breast reconstruction. Yet, most mastectomy patients receive implant reconstructions (ImBR). Independent and active decision makers have shown mainly to choose for autologous reconstructions, such as the Deep inferior epigastric perforator (DIEP) flap (DiepBR). To further explore the decision making to opt for either ImBR or DiepBR, we investigated patient knowledge, informational resources used, effect of plastic surgeons advice, coping style and personal independence.nnnMETHODSnA total of 153 women, who were planned for DiepBR or ImBR preoperatively, completed a study-specific and standardised validated psychological questionnaire. Analyses were aimed at information-seeking behaviour, personal independence and coping styles associated with autonomous decision making regarding reconstruction.nnnRESULTSnDiepBR women reported different informational resources to be very important and they were more active information seekers, compared with ImBR women. ImBR women found their physicians advice to be more important in their decision making than DiepBR women. Actively seeking for information regarding BR was positively correlated with active coping, sensitivity to others and the decision for DIEP-flap BR.nnnCONCLUSIONSnWomen opting for DIEP-flap BR were more active and independent in their decision making regarding the type of BR. Women opting for implant BR seemed less well-informed and more dependent on their physician in their decision compared with women opting for DIEP-flap BR. To undergo a complex type of BR, active and independent information seeking may be required. However, clinical and logistic characteristics need to be considered, as some patients were limited in their reconstruction options.

Adjunctive treatment of keloids: comparison of photodynamic therapy with brachytherapy

BackgroundThe aesthetic result after brachytherapy, especially hypopigmentation, remains a significant problem. Given that brachytherapy may be carcinogenic, it is difficult to recommend this treatment in young patients. For these reasons, there is a need for alternatives to radiation.MethodsThe purpose of this study was to evaluate the effectiveness of adjuvant photodynamic therapy (PDT) using aminolevulinic acid after keloid excision and to compare it to keloid excision followed by brachytherapy. To assess outcome, the Patient and Observer Scar Assessment Scale (POSAS) was used.ResultsThirty-four patients treated for 45 keloids were evaluated. Twenty-two patients (27 lesions) received brachytherapy and 12 (18 lesions) received PDT. The observers scored a mean POSAS of 19.1 (range 13.0–34.0) for brachytherapy and 24.6 (range 11.0–37.0) for PDT (pu2009=u20090.005). The independent observers scored a mean POSAS of 14.6 (range 10.0–20.0) for brachytherapy and 18.6 (range 9.0–42.0) for PDT (pu2009=u20090.018). The patients reported a significantly better mean POSAS score after brachytherapy (22.8, range 7.0–53.0) than following PDT (34.2, range 11.0–63.0). The patients’ POSAS score showed no significant difference for the item “general impression” for both treatment groups; the observers scored significantly higher for PDT treatment. The independent observers revealed a higher score for general impression after PDT although not reaching significance.ConclusionsPatients and observers appear to be more satisfied with the results after brachytherapy than PDT. However, patients still have a positive general impression after PDT. Adjunctive aminolevulinic acid–PDT for the treatment of keloids could be used as an alternative for brachytherapy.Level of Evidence: Level IV, therapeutic study.