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Study Shows Satisfaction with Breast Implant Reconstruction Diminishes Over Time, More Women Satisfied with Muscle Flap Reconstruction (dateline July 6, 2001)

In a study conducted by French researchers, women who underwent breast reconstruction with implants, either saline-filled or silicone, tended to be less satisfied with the cosmetic results of the surgery as time passed. According to the researchers, a main reason for this diminished satisfaction with implant reconstruction could be the way in which the reconstructed breast and non-reconstructed breast look increasingly different over time. By contrast, women who had a certain type of reconstruction using their own abdominal tissue (called TRAM flap) tended to be much happier with the cosmetic results of the surgery years after the procedure was performed.

The study of breast implant reconstruction consisted of 360 women who received implants between 1989 and 1997 after having breast cancer surgery (mastectomy). Of the 334 women who were evaluated, 86% of the women were happy with the cosmetic results of the implant surgery after two years. However, after five years, the number of women who were satisfied with their implant surgery decreased significantly to only 54% of the women.

According to lead researcher Krishna B. Clough, MD, of the Institut Curie in Paris, the decline in cosmetic outcome of breast implant reconstruction was not associated with the type of implant used, the volume of the implant, the age of the patient, or the type of mastectomy incision used during surgery. Radiation therapy was also not a significant factor in the patients’ diminished happiness with the surgery since only 28 of the patients received radiation. About one third of the patients did need revisional surgery sometime after the initial implant surgery.

The only factor that Dr. Clough and her colleagues were able to directly attribute to a significant reduction in patient satisfaction was the occurrence of capsular contracture—a condition in which the scar around the implant begins to tighten and squeeze down on the soft implant, causing the breast to feel hard. After re-examining photographs of the patients without capsular contracture, the researchers suggest the different rate at which the reconstructed and non-reconstructed breasts "aged" is likely to be a significant factor in diminished patient satisfaction with implant surgery. This appears to be the case even though more than 90% of the patients who underwent implant surgery had some type of surgery on the other breast so that it would "match" better.

The researchers also followed 171 women who had TRAM flap breast reconstruction to determine their satisfaction with the procedure. TRAM flap reconstruction involves using the patient’s own abdominal tissue to reconstruct the breast. Muscle flap procedures (such as TRAM flap) tend to take much longer to perform than implant operations and involve longer recovery periods. However, the researchers found that 96.4% of the women were happy with the procedure after two years and 94.2% were satisfied after five years. This is consistent with anecdotal evidence which has found that a breast reconstructed with a patient’s own tissue tends to look and feel more natural to the patient than a breast reconstructed with implants.

However, some women may be better candidates for one procedure over another. For example, women who smoke or have diabetes, vascular, or connective tissue diseases cannot typically have muscle flap breast reconstruction because the surgery involves the blood vessels. Other women may choose not to have breast reconstruction after breast cancer surgery or wait several years before having reconstruction. For these women, there are a number of alternatives, including breast prostheses (artificial forms), special mastectomy bras, mastectomy swimsuits, and more.

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