Abstract
INTRODUCTION: Breast cancer is a significant global health challenge, particularly in Egypt, where mastectomy rates have risen due to increased awareness and advancements in breast imaging. This study investigated the impact of immediate breast reconstruction following mastectomy on quality of life (QoL) in Egyptian women during the COVID-19 pandemic. The research examined three abdominal flap techniques and their effect on patient QoL. Recognizing the scarcity of prior research in Egypt on advanced breast reconstruction and the limited implementation of multidisciplinary care models, this study aimed to address this gap in the literature. PATIENTS AND METHODS: This single-center, prospective, non-randomized interventional study, conducted in Egypt between August 2020 and August 2022, involved 36 female patients who underwent breast reconstruction following mastectomy. Participants were classified into three groups (pedicled MS-TRAM flap, free DIEP flap, and delayed free DIEP flap) based on flap selection, guided by surgeon and patient counseling. While surgical techniques varied, preoperative assessments and postoperative care were standardized across all groups. QoL was assessed using the BREAST-Q assessment tool, with one assessment occurring 12 months after surgery. RESULTS: This study showed that the three surgical groups demonstrated similar QoL outcomes, as assessed by the BREAST-Q. There were no significant differences in satisfaction with breast appearance, psychological well-being, sexual well-being, physical well-being of the abdomen, or physical well-being of the chest and upper body (p > 0.05 for all comparisons). Operative time was significantly longer for the free DIEP flap group compared to the MS-TRAM and delayed free DIEP groups (P = 0.001). Postoperative complications were infrequent and comparable across the groups, with no significant differences in total flap necrosis, partial flap loss, or fat necrosis (P =1.0 for all comparisons). The use of mesh support varied significantly among the groups, with 100% utilization in the MS-TRAM group compared to 34% in the free DIEP group and 16.7% in the delayed free DIEP group (P = 0.015 and P = 0.06, respectively). CONCLUSION: In this Egyptian study, immediate unilateral ABR using different abdominal flap techniques resulted in similar QoL outcomes using BREAST-Q. This suggests that flap choice does not significantly impact patient well-being and satisfaction. Despite the limitations of this study, it emphasizes the importance of individualized surgical approaches based on patient needs and surgeon experience, particularly in resource-constrained settings. Further research is needed to validate these findings and explore long-term outcomes. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .