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Michigan Breast Reconstruction Outcome Study ResultsReconstruction vs. No ReconstructionThe Michigan Breast Reconstruction Outcome Study (MBROS) reports that a group of 250 breast reconstruction patients showed statistically significant psychological and functional gains one year after their operations, regardless of which type of breast reconstruction procedure they chose (1). They improved in mental health, emotional well-being, energy level, ability to perform normal daily activities, and satisfaction with the way their breasts looked. This study does not include a control group of breast cancer patients who did not have breast reconstruction for comparison. However, other studies have shown that patients who undergo breast reconstruction have better body images, self esteem, and sexual functioning than patients who do not have reconstruction (2-5).
Immediate vs. Delayed Breast Reconstruction:The Michigan Breast Reconstruction Outcome Study (MBROS) surveyed 250 breast reconstruction patients before surgery and one year after surgery. Two thirds (161) of the patients chose immediate reconstruction, while one-third (89) chose delayed reconstruction. The study found that there were no differences between immediate and delayed reconstruction in the amount of improvement patients observed in general mental health, emotional well-being, or ability to perform normal daily activities (1). Not surprisingly, since they started with no breast, those who chose delayed reconstruction experienced the greatest improvements in their feelings about the way they looked after reconstruction. Of the women who had delayed reconstruction, those who chose implants had higher energy levels than those who chose natural tissue reconstruction. However, they also reported being less satisfied with the way the results looked. There were no differences in energy level or in satisfaction with the results among those who had immediate breast reconstruction, regardless of which procedure they chose.
Implants vs. "Tunneled" and "Free" TRAMs:The Michigan Breast Reconstruction Outcome Study (MBROS) surveyed 212 breast reconstruction patients one year after their surgeries to determine how satisfied they were with the results. 23% of the women chose implants; 48% chose "tunneled" TRAMS, and 29% chose free TRAMS (1-2). General Patient SatisfactionWomen who chose TRAMs of either type were 2.17 times as likely as women who chose implants to be satisfied in general with their breast reconstructions (p < 0.033, which means that there is a 3.3% probability that these results are due to chance). 77.8% of TRAM patients (both "tunneled" and free TRAMs) were "very satisfied" with their results in general, compared with 61.2% of implant patients (p < 0.021). Patients who were physically active before the surgery were 1.68 times more likely to be satisfied with their surgeries than those who were not (p < 0.034). This greater satisfaction among women who are active may be explained by the fact that people who exercise regularly are likely to have better health status and better emotional health, which means that they are likely to have fewer surgical complications and better outcomes. The age of the patient made no difference in how satisfied she felt with the results of her surgery. Patient Satisfaction With Appearance of Reconstructed BreastsWomen who chose TRAMs of either type were also 4.7 times as likely as women who chose implants to be satisfied with the appearance of their reconstructed breasts (p < 0.0001, which means that there is a one in 10,000 probability that these results are due to chance). 75.2% of TRAM patients reported being "very satisfied" with the aesthetic results of their surgery, compared with 40.4% of implant patients (p < 0.001). Those who chose "tunneled" TRAMs were twice as likely as those who chose free TRAMs (p < 0.047) and 6.67 times as likely as those who chose implants (p < 0.01) to be satisfied with the looks of their new breasts. The physical activity level and age of the patient had no effect on their satisfaction with the aesthetic results of their surgery. Objective Measurements of Symmetry of Reconstructed vs. Natural BreastsThe womens' assessments of the appearance of their reconstructed breasts are confirmed by objective measurements. Another MBROS study (3) examined computer-generated measurements of photographs of the breasts of women who had undergone "tunneled" TRAMs, free TRAMs, and implants, in order to determine the degree of symmetry achieved using the different reconstructive techniques. This study found that TRAMs yielded more symmetrical results than implants in all four dimensions examined. (The results in three out of four of these dimensions were statistically significant.) Furthermore, "tunneled" TRAMs produced more symmetrical results in all dimensions than did free TRAMs. Overall, there was an average difference in measured dimensions between the natural and the reconstructed breast of 3.15% for "tunneled" TRAMs, compared to 4.21% for free TRAMs and 4.91% for implants (p < 0.028). Effects on Physical FunctioningIn another MBROS study (4), 71 women were tested both before their surgeries and one year afterwards to determine the effects of different breast reconstruction techniques on physical functioning. 23% of the women had implants, 37% had "tunneled" TRAMs, and 40% had free TRAMs. One year after their operations, the women who had TRAMs , whether "tunneled" or "free," had less sit-up power than those who had implants reconstructions (p < 0.001). There were no significant differences between procedures in other physical tests, such as lifting the arm from the shoulder or bending deeply at the waist. Moreover, based on questionnaire results one year after surgery, regardless of the type of breast reconstruction, the women reported no differences in their ability to perform normal daily activities. Thus, although both types of TRAMs interfere somewhat with abdominal muscle function, there appears to be no effect on the performance of daily activities.
Mammography for TRAMs ("Tramograms"):The Michigan Breast Reconstruction Outcome Study (MBROS) reports that, under certain conditions, recurrence of cancer in TRAM patients, although rare, may be frequent enough to warrant routine mammography (1). The study reports four case studies of TRAM patients who experienced local recurrences of cancer or new cancers in their reconstructed breasts. The patients shared the following characteristics:
Three of the cases were detected on physical examination by a physician. One was detected by a mammogram. All recurrences occurred within five years of the mastectomy and TRAM flap reconstruction. Mammography of reconstructed breasts is controversial, as recurrence of cancer in reconstructed breasts is very rare. A 1997 review of 1707 reconstruction patients reports recurrence of cancer in only 1.4% of the cases (2). Moreover, benign irregularities in the flap tissue, such as fat necrosis, oil cysts, and scar tissue, can easily be mistaken for cancer in a mammogram. In some cases, recurrence of cancer may be detected earlier with a mammogram than with physical examination. However, it has not been proven that recurrences detected by mammogram can be treated more successfully than those detected by physical exam. On the other hand, if the recurrences can be treated earlier, it will minimize the damage done by the cancer and may make it possible to save the TRAM flap.
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