Reconstrução de mama: resultado cosmético, satisfação, qualidade de vida e a proposição de uma nova escala de avaliação estética

Abstract

Introduction: Breast reconstruction is a complementary treatment to mastectomy, aimed at restoring the breast mound, improving satisfaction, and enhancing the quality of life for these women. Objective: This research aims to evaluate breast reconstruction considering cosmetic results, personal satisfaction, and quality of life, compare the aesthetic assessment of plastic surgeons with general practitioners, and propose a new aesthetic evaluation scale for reconstructed breasts using discrete variables. Methodology: This study presents two designs: the first is a cross-sectional observational study, and the second is a methodological study. The sample consisted of 46 women who underwent breast reconstruction at the University Hospital of the Federal University of Sergipe (HU-UFS). Quality of life was assessed using the WHOQOL-bref questionnaire, and sociodemographic and clinical variables were collected through a form. Aesthetic results were evaluated by 5 plastic surgeons with 10 or more years of experience in Plastic Surgery, experienced in breast reconstruction, and full members of the Brazilian Society of Plastic Surgery; the scales used were the Garbay scale and the one suggested by this study. Twenty women with the best (7), average (6), and worst (7) aesthetic results were selected and subsequently evaluated by another 16 plastic surgeons and 16 general practitioners. The significance level adopted was 5%. This study was approved by the HU-UFS research ethics committee. All study subjects signed the informed consent form. Results: Patients with delayed reconstruction had a better quality of life in the physical domain than those with immediate reconstruction (p=0.032), although no better cosmetic result or satisfaction with the operated breast was observed. Patients with better-positioned breasts were more satisfied. For patients with reconstruction using the Latissimus Dorsi muscle flap, a positive and significant correlation was observed between satisfaction with the operated breast and shape (r = 0.54, p-value = 0.026) and position (r = 0.68, p-value = 0.003). Plastic surgeons rated the aesthetic result of the patients more positively compared to general practitioners. The aesthetic evaluation scale suggested by this study obtained valid intraclass correlation coefficients, 0.9 for the overall aesthetic evaluation of the breast, and the lowest was for the definition of the inframammary fold, 0.77. The area under the curve ranged from 0.85 to 0.97. Conclusion: This study showed that reconstructed women feel more satisfied with their breasts when the neo-breast is better positioned, although this result does not impact quality of life. Women with delayed reconstruction had a better quality of life in the physical domain compared to women with immediate reconstruction; however, there were no differences in aesthetic evaluation or satisfaction. Plastic surgeons rated the breast reconstruction results higher than general practitioners, with a positive correlation regarding the length of experience in plastic surgery. The scale suggested by this study proved effective in evaluating the aesthetic results of the reconstructed breast.