Determinants of patient satisfaction in postmastectomy breast reconstruction

In today's increasingly competitive health care marketplace, consumer satis faction has become an important measure of quality. Furthermore, measures o f satisfaction with treatment interventions are influential factors in dete rmining patients' and payers' choices of health care. This study sought to evaluate satisfaction with postmastectomy breast reconstruction and to asse ss the effects of procedure type and timing on patient satisfaction. As part of the Michigan Breast Reconstruction Outcome Study, patients under going first-time mastectomy reconstruction were prospectively evaluated, in cluding cohorts of women choosing expander/implant, pedicle TRAM flap, and free TRAM flap procedures. Preoperatively and 1 year postoperatively, parti cipants completed a questionnaire that collected a variety of health status information. The postoperative questionnaire had an additional seven items assessing both general satisfaction with reconstruction (five items) and a esthetic satisfaction (two items) as separate subscales. Patients were aske d to respond to each item using a five-point Likert scale. Item responses r anged from 1, indicating high satisfaction, to 5, reflecting low satisfacti on. In the data analysis, only patients responding with a 1 or 2 for all of the items within a subscale were classified as "satisfied" for the subscal e. To assess the effects of procedure type (implant, pedicle TRAM flap, and free TRAM flap) and timing (immediate versus delayed) on satisfaction and to control for possible confounding effects from other independent variable s multiple logistic regression was employed. In our analysis, odds ratios a nd associated 95 percent confidence intervals were calculated for each inde pendent variable in the regression. Statistical significance was designated at the p less than or equal to 0.05 level. A total of 212 patients were followed during the period of 1994 to 1997, in cluding 141 immediate and 71 delayed reconstructions. The study population consisted of 49 expander/implant, 102 pedicle TRAM flap, and 61 free TRAM f lap reconstruction patients. The analysis showed a significant association between procedure type and patient satisfaction. TRAM flap patients (both f ree and pedicle) appeared to have significantly greater general and aesthet ic satisfaction compared with expander/implant patients (p = 0.03 and 0.001 , respectively). Furthermore, pedicle TRAM flap patients were more aestheti cally satisfied than those with free TRAM flaps (p = 0.072). The other inde pendent variables of age and procedure timing did not appear to significant ly affect either general or aesthetic satisfaction. However, preoperative p hysical activity was positively correlated with general satisfaction at the p = 0.034 level. The choice of procedure seems to have a significant effect on both aestheti c and general patient satisfaction with breast reconstruction. In this stud y, autogenous tissue reconstructions produced higher levels of patient aest hetic and general satisfaction compared with implant techniques. Pedicle an d free TRAM flap patients do not seem to differ significantly in general sa tisfaction. However, women receiving pedicle TRAM flaps reported greater ae sthetic satisfaction compared with patients undergoing free TRAM flaps. Fur thermore, patient age and procedure timing may not have an effect on patien t satisfaction with breast reconstruction.