Quality of life, patients' satisfaction, and aesthetic outcome after pedicled or free TRAM flap breast surgery

Breast reconstructions after breast cancer surgery are primarily performed to improve patients' quality of life. This study was performed to investiga te patients' satisfaction with breast reconstruction and quality of life af ter pedicled or free transverse rectus abdominis musculocutaneous (TRAM) fl ap surgery and to evaluate the aesthetic result of the bl east reconstructi on both objectively and subjectively. Sixty-three patients (36 with pedicled flaps and 27 with free TRAM flaps) a nswered two questionnaires: of this group, 59 (27 with pedicled flaps and 2 6 with free TRAM flaps) participated in an aesthetic evaluation. The questi on!lair es consisted of two parts: one study-specific part concerning satis faction with the result of the breast reconstruction, the other a standardi zed health-related quality of life part, the: Short Form-36 questionnaire. The aesthetic examination consisted of all objective part in which various distances on the reconstructed and contralateral breast were measured. The volumes of the breasts were measured using a thermoplastic cast system. The softness of the breasts was assessed using applanation tonometry. A panel consisting of three plastic surgeons looked at four standardized phc,tc,gra phs of each patient and evaluated the aesthetic outcome subjectively. The p anel evaluated the breast reconstruction on 10 subscales. No statistically significant difference between the surgical groups was see n regarding tile patients' satisfaction with the reconstruction. In the pat ients' self-assessment of the cosmetic outcome, the degree of symmetry was assessed higher in the free TRAM flap group. The health-related quality of life short For-tn-Sti questionnaire revealed no difference between the pedi cled and free flap groups. Compared with a reference population, the breast -reconstructed group felt more tired and "worn out," less peaceful, more un happy. and more restless. The free flap group reached a higher degree of sy mmetry in the objective evaluation and received generally higher scores fi- om the three-member panel. compared with the pedicled TRAM flap group. A st rong correlation between the patients' and the panel's evaluations of the c osmetic outcome was seen; generally, the panel's evaluation of the cosmetic result of the breast correlated with the satisfaction of the patients.