J Breast Cancer.  2017 Mar;20(1):98-103. 10.4048/jbc.2017.20.1.98.

Patient Satisfaction with Implant Based Breast Reconstruction Associated with Implant Volume and Mastectomy Specimen Weight Ratio

• Baek WY
• Byun IH
• Kim YS
• Lew DH
• Jeong J
• Roh TS

• KMID: 2379404
• DOI: http://doi.org/10.4048/jbc.2017.20.1.98

Abstract

PURPOSE
Breast volume assessment is one of the most important steps during implant-based breast reconstruction because it is critical in selecting implant size. According to previous studies, there is a close relationship between the mastectomy specimen weight and resected breast volume. The aim of this study was to evaluate long-term patient satisfaction with implant-based breast reconstruction guided by the ratio of implant volume to mastectomy specimen weight. In doing so, we describe the ideal ratio for patient satisfaction.
METHODS
A total of 84 patients who underwent implant-based breast reconstruction for breast cancer were included in this study. The patients were grouped by the ratio of implant size to mastectomy specimen weight (group 1, <65%; group 2, 65%-75%; and group 3, >75%). Outcome analysis was performed using a questionnaire of patient satisfaction and the desired implant size.
RESULTS
Patient satisfaction scores concerning the postoperative body image, size, and position of the reconstructed breast were significantly higher in group 2. The average ratio of the ideal implant volume to mastectomy specimen weight for each group was 71.9% (range, 54.5%-96.7%), with the differences across the three groups being not significant (p=0.244).
CONCLUSION
Since there is an increase in breast reconstruction, selecting the appropriate breast implant is undoubtedly important. Our novel technique using the ratio of implant volume to mastectomy specimen weight provides physicians a firm guide to intraoperative selection of the proper implant in reconstructive breast surgery.

Keyword

Breast implants; Mammaplasty; Patient satisfaction

MeSH Terms

Body Image
Breast Implants
Breast Neoplasms
Breast*
Female
Humans
Mammaplasty*
Mastectomy*
Patient Satisfaction*

Figure

• 

  Figure 1 The ideal new ratio in relation to the original ratio of implant volume to specimen weight. X-axis, the ratio of implant volume to mastectomy specimen weight (%); Y-axis, the new ratio recalculated with the ideal implant volume which patients desired (%). Sixty-one patients (61/84, 72.6%) resulted new ratios located within 65.0% to 75.0%.

Reference

1. Tzafetta K, Ahmed O, Bahia H, Jerwood D, Ramakrishnan V. Evaluation of the factors related to postmastectomy breast reconstruction. Plast Reconstr Surg. 2001; 107:1694–1701.

2. Vega S, Smartt JM Jr, Jiang S, Selber JC, Brooks CJ, Herrera HR, et al. 500 Consecutive patients with free TRAM flap breast reconstruction: a single surgeon's experience. Plast Reconstr Surg. 2008; 122:329–339.

3. Duggal CS, Grudziak J, Metcalfe DB, Carlson GW, Losken A. The effects of breast size in unilateral postmastectomy breast reconstruction. Ann Plast Surg. 2013; 70:506–512.

4. Noone RB. Thirty-five years of breast reconstruction: eleven lessons to share. Plast Reconstr Surg. 2009; 124:1820–1827.

5. Spear SL, Spittler CJ. Breast reconstruction with implants and expanders. Plast Reconstr Surg. 2001; 107:177–187.

6. Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plast Reconstr Surg. 1982; 69:195–208.

7. Salzberg CA, Ashikari AY, Koch RM, Chabner-Thompson E. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg. 2011; 127:514–524.

8. Roostaeian J, Pavone L, Da Lio A, Lipa J, Festekjian J, Crisera C. Immediate placement of implants in breast reconstruction: patient selection and outcomes. Plast Reconstr Surg. 2011; 127:1407–1416.

9. Caulfield RH, Niranjan NS. Innovative techniques: a novel technique for intraoperative estimation of breast implant size in aesthetic and reconstructive breast surgery. Aesthetic Plast Surg. 2008; 32:126–129.

10. Kayar R, Civelek S, Cobanoglu M, Gungor O, Catal H, Emiroglu M. Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases. Breast Cancer (Auckl). 2011; 5:43–52.

11. Shamoun JM, Hartrampf CR. Mastectomy specimen weight and skin dimensions as an adjunct in breast reconstruction. Ann Plast Surg. 1996; 36:251–254.

12. Yoo A, Minn KW, Jin US. Magnetic resonance imaging-based volumetric analysis and its relationship to actual breast weight. Arch Plast Surg. 2013; 40:203–208.

13. Katariya RN, Forrest AP, Gravelle IH. Breast volumes in cancer of the breast. Br J Cancer. 1974; 29:270–273.

14. Malini S, Smith EO, Goldzieher JW. Measurement of breast volume by ultrasound during normal menstrual cycles and with oral contraceptive use. Obstet Gynecol. 1985; 66:538–541.

15. Fowler PA, Casey CE, Cameron GG, Foster MA, Knight CH. Cyclic changes in composition and volume of the breast during the menstrual cycle, measured by magnetic resonance imaging. Br J Obstet Gynaecol. 1990; 97:595–602.

16. Daly SE, Kent JC, Huynh DQ, Owens RA, Alexander BF, Ng KC, et al. The determination of short-term breast volume changes and the rate of synthesis of human milk using computerized breast measurement. Exp Physiol. 1992; 77:79–87.

17. Ward C, Harrison B. The search for volumetric symmetry in reconstruction of the breast after mastectomy. Br J Plast Surg. 1986; 39:379–385.

18. Bulstrode N, Bellamy E, Shrotria S. Breast volume assessment: comparing five different techniques. Breast. 2001; 10:117–123.

19. Yip JM, Mouratova N, Jeffery RM, Veitch DE, Woodman RJ, Dean NR. Accurate assessment of breast volume: a study comparing the volumetric gold standard (direct water displacement measurement of mastectomy specimen) with a 3D laser scanning technique. Ann Plast Surg. 2012; 68:135–141.

20. Caruso MK, Guillot TS, Nguyen T, Greenway FL. The cost effectiveness of three different measures of breast volume. Aesthetic Plast Surg. 2006; 30:16–20.

21. Palin WE Jr, von Fraunhofer JA, Smith DJ Jr. Measurement of breast volume: comparison of techniques. Plast Reconstr Surg. 1986; 77:253–255.

22. Longo B, Farcomeni A, Ferri G, Campanale A, Sorotos M, Santanelli F. The BREAST-V: a unifying predictive formula for volume assessment in small, medium, and large breasts. Plast Reconstr Surg. 2013; 132:1e–7e.

23. Parmar C, West M, Pathak S, Nelson J, Martin L. Weight versus volume in breast surgery: an observational study. JRSM Short Rep. 2011; 2:87.

24. Aslan G, Terzioğlu A, Tuncali D, Bingul F. Breast reduction: weight versus volume. Plast Reconstr Surg. 2003; 112:339–340.

25. Hu ES, Pusic AL, Waljee JF, Kuhn L, Hawley ST, Wilkins E, et al. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship period. Plast Reconstr Surg. 2009; 124:1–8.