The findings come from a new Canadian study published online Monday in CANCER, a peer-reviewed journal of the American Cancer Society.
“Regardless of whether a patient had complications after surgery or not … we saw that, universally, their abdomen was the one that really took a big hit,” said the study’s lead author Dr. Toni Zhong from the University of Toronto’s University Health Network Breast Restoration Program.Until now, surgeons believed the advanced microsurgery aimed at preserving the nerve and muscle lessened the chance women would experience loss of abdominal muscle function. Finding that is not always the case, Zhong said the study can help breast cancer patients and their surgeons better decide which reconstructive option is best for the patient.
The researchers surveyed 51 women between June 2009 and November 2010 undergoing breast reconstruction at the University of Toronto.
They looked only at women undergoing reconstruction that uses skin, fat and blood vessels — not muscle — from the abdominal region to build a new breast, called a DIEP flap or a muscle-sparing TRAM flap.
“We wanted to look specifically at the DIEP flap … because it is becoming an extremely popular choice among women, and there’s a lot of public interest in it from our patients,” said Zhong.
In the study, the first of its kind to look at the quality of life for breast cancer patients and the level of satisfaction with their new breasts after muscle-sparing breast reconstructive surgery, patients were surveyed on their psychosocial, sexual and physical well-being and their level of depression or anxiety.
The women answered the questions before surgery, at three weeks after surgery, and at three months after surgery.
The results found that, as early as three weeks after surgery, women were significantly more satisfied with their new breasts and experienced an improved quality of life. Even in the 11 patients who experienced complications after surgery, their satisfaction with the breast reconstruction was still high, the authors reported.
But Zhong said she was surprised to find that even during in the most careful attempts to remove tissue without disturbing muscle, patients sometimes experienced muscle weakness or a bulge that persisted even three months after surgery.
“It’s not to the point that they’re bed-ridden or can’t do everyday activities, but they can feel a little more weak and not have the strength they used to have,” said Zhong. “Some people are happy to put up with it and say it’s the price that I paid in order to have such a great breast reconstruction.”
But for active patients that notice the loss of muscle strength, it can be a problem, she said.
From her experience, Zhong said many patients do regain their abdominal strength through therapy, but a bulge could require more surgery to tighten the muscles.
Zhong said the study’s findings change the way she, and other plastic surgeons, will present reconstructive options to women in the future.
“Prior to this, I think most plastic surgeons counsel women that you can expect decreased abdominal function for eight weeks, but after that you can get back to your normal life,” said Zhong. “Now we’re more cautious when we counsel women to have this surgery.”
This study’s results strayed from other findings that saw a deterioration of quality of life, psychological and social well-being after breast reconstruction.
However, the authors said it is likely because other studies looked at all different types of reconstruction, including the use of tissue expanders and implants which is a two-stage surgery process and takes longer to see the final results.
Zhong said she is working on an update for the study looking at the same patients’ abdominal function after six months and one year after surgery.
By:Thandi Fletcher
Source:Postmedia News
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