Breast softness in patients randomised to postmastectomy breast reconstruction with an expander prosthesis or DIEP flap

Background Objectively measured breast softness in reconstructed breasts and its relation to patients’ subjective satisfaction
with breast softness has not yet been investigated. The aim of this study was to evaluate breast softness in patients 1 year
following delayed breast reconstruction with an expander prosthesis (EP) or deep inferior epigastric perforator (DIEP) fap,
using objective and subjective methods.
Methods Seventy-three patients were randomised to breast reconstruction with an EP or DIEP fap between 2012 and 2018.
Of these, 69 completed objective evaluation at a mean of 25 (standard deviation, SD 9.4) months following breast reconstruction. Objective evaluation included measurements of breast volume, jugulum-nipple distance, clavicular-submammary fold
distance, ptosis and Baker scale grading. Breast softness was assessed with applanation tonometry. Subjective evaluation
was performed using the BREAST-Q questionnaire.
Results Objectively, DIEP faps were signifcantly softer than EP breast reconstructions. Non-operated contralateral breasts
were signifcantly softer compared with reconstructed breasts. In the subjective evaluation, the median score on the question
(labelled 1.h) “How satisfed or dissatisfed have you been with the softness of your reconstructed breast (s)?” was higher in
the DIEP fap group corresponding to greater satisfaction in this group. A fair correlation was found between the applanation
tonometry and the patient-reported satisfaction with the reconstructed breast’s softness (rs=0.37).
Conclusions In terms of breast softness, breast reconstructions with DIEP faps result in more satisfed patients. Concerning
applanation tonometry as an objective tool for