Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction

Objective: Breast reconstruction is associated with multiple psychological benefits. However, few studies have identified clinical and psychological factors associated with improved satisfaction and quality of life. This study examined factors which predict satisfaction with breast appearance, outcome satisfaction and quality of life following post-mastectomy breast reconstruction. Methods: Women who underwent post-mastectomy breast reconstruction between 2010 and 2016 received a postal questionnaire consisting of: The BREAST-Q Patient Reported Outcomes Instrument, The European Organisation for Research and Treatment of Cancer QLQ-30 Questionnaire, The Patient and Observer Scar Assessment Scale and a series of Visual-Analogue Scales. One hundred and forty eight women completed the questionnaire, a 56% response rate. Results: Hierarchical multiple regression analyses revealed psychosocial factors accounted for 75% of the variance in breast satisfaction, 68% for outcome satisfaction and 46% for quality of life. Psychosocial wellbeing emerged as a significant predictor of satisfaction with breast appearance (β=.322) and outcome satisfaction (β=.406). Deep inferior epigastric perforator flap (DIEP) patients reported greater satisfaction with breast appearance (β=.120) and outcome satisfaction (β=.167). Conclusions: This study extends beyond limited research by distinguishing between satisfaction with breast appearance and outcome satisfaction. The study provides preliminary evidence for the role of psychosocial factors predicting key patient reported outcomes and demonstrates the importance of psychosocial wellbeing and reconstruction type. Healthcare providers could assess psychosocial wellbeing prior to reconstruction to support optimal recovery. Clinicians could also use the findings of this study to justify the use of DIEP over implant reconstructions.