Comparison of Quality of Life, Patient Satisfaction and Overall Postoperative Pain between Breast Reconstruction with Transverse Rectus Abdominis Myocutaneous Flap and Breast-Conserving Therapy in Breast Cancer Patients: A Single Surgeon Experience
Yenbutra P, MD, FRCST1,2, Amornpisanmit P, MD1
Affiliation : 1 Department of Surgery, Rajavithi Hospital, Department of Medical Services, Ministry of Public Health of Thailand, Bangkok, Thailand. 2 Department of Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
Background : Breast cancer is the most common cancer in Thai women; however, recent advances in its treatment not only achieve
complete cure but also improve the quality of life of the patient. Two such methods, breast reconstruction with transverse rectus
abdominis myocutaneous flap (TRAM) and breast-conserving therapy (BCT) are employed in order to maintain the patient’s body
image. Unfortunately, both of these types of operation may entail complications and extended treatment processes that adversely
affect the patient’s quality of life. As 80% of women with breast cancer survive for more than 5 years, quality of life, patient
satisfaction and overall postoperative pain are important factors to consider when choosing the most appropriate operation for
each patient.
Objective : The aim of this study was to assess differences in quality of life, patient satisfaction and overall postoperative pain
between women who underwent mastectomy with immediate breast reconstruction with transverse rectus abdominis
myocutaneous flap (TRAM) and those who had breast-conserving therapy (BCT) in Rajavithi Hospital. Both types of operation
were performed by a single surgeon.
Materials and Methods : A cross-sectional study was conducted during follow-up visits. From June 2013 to June 2015, 19 patients
who underwent transverse rectus abdominis myocutaneous flap (TRAM) after mastectomy and 19 who underwent breast-
conserving therapy (BCT) were enrolled. All patients who underwent treatment attended at least 2 years’ follow-up, and their
ages ranged from 20 to 70 years old. Quality of life was evaluated based on the World Health Organization Quality of Life assessment
instrument (WHOQOL-BREF-THAI) in the Thai language. There are 5 separate domains for evaluation of quality of life, namely
the physical, mental, psychological, environmental and overall domains. During follow-up telephone interviews, patients were
asked to grade their satisfaction on a 5-point Likert scale (5 points for extremely satisfied and 1 point for extremely
dissatisfied). We also assessed the patients’ overall postoperative pain using the visual analog scale (0 for no pain and 10 points for
maximal pain).
Results : A total of 38 patients completed the questionnaire. The mean age of TRAM flap group was 46.37+9.96 years compared with
53.47+9.49 years in the BCT group. Women who underwent breast reconstruction with TRAM flap showed better overall and
physical domain quality of life than those who had BCT; however, there was no significant difference in the mental, psychological
and environmental domains. There was no statistically significant difference between the two groups in terms of patient satisfaction
and overall pain score.
Conclusion : When selecting the most appropriate operation for breast cancer patients, the surgeons should take into account not
only body image but also patient quality of life.
Keywords : Immediate breast reconstruction, Transverse rectus abdominis myocutaneous flap (TRAM), Breast conserving-therapy (BCT), Quality of life, Patient satisfaction, Postoperative pain
