NEW ORLEANSComputer-generated measurements evaluating breast
symmetry offer objective evidence that breast reconstruction using
natural tissue rather than implants creates better aesthetic results,
according to preliminary findings of the Michigan Breast
Reconstruction Outcome Study (MBROS). The findings were presented at
the 68th Annual Scientific Meeting of the American Society of Plastic
and Reconstructive Surgeons (now known as the American Society of
These objective data mirror the researchers data on
patient satisfaction, which were presented at the annual meeting of
the American Association of Plastic Surgeons in Colorado Springs in
May of this year.
It is important to use valid and reliable methods to measure
the long-term success of these surgeries, principal
investigator Edwin G. Wilkins, MD, said in an interview with ONI. Dr.
Wilkins is associate professor, Division of Plastic Surgery,
University of Michigan, Ann Arbor, and research investigator, Center
for Practice Management and Outcomes Research, Ann Arbor Veterans
Administration Medical Center. Third-year medical student Jennifer
Reynolds presented the data at the meeting.
Subjective ratings of surgical results among plastic surgeons have
yielded poor inter- and intra-rater reliability, he said. The
Michigan study strives to identify more reliable measures of success.
Digitized images, in lieu of gold-standard tape measurement and
plaster-casting methods, allow an easier means of evaluating
measurements of breast symmetry to identify success objectively.
In the current study, the researchers evaluated 2-year postoperative
photographs from 84 patients who had undergone breast reconstruction
after mastectomy. Photographs were converted to digital images for
computer analysis based on anterior and lateral dimensions of linear
and volumetric symmetry.
Twenty-seven patients had undergone reconstruction with
tissue-expander/implant surgery, 27 had received a free transverse
rectus abdominis myocutaneous (TRAM) procedure, and 30 had undergone
a pedicle TRAM procedure.
The objective measures revealed that procedures using natural tissue
yielded more symmetrical results than implants (P < .028). The
pedicle TRAM, in which the patients tissue remains attached to
its original site and is tunneled beneath the skin to the chest,
produces marginally better symmetry than the free TRAM, in which the
tissue is removed and transplanted to the chest (P < .06).
The amazing part is that patient satisfaction matched these
objective results. This is not something I would have predicted,
Dr. Wilkins said. Results presented in May showed that women who
chose TRAM procedures were 2.7 times more likely than women who chose
implants to be generally satisfied with their results 1 year after
surgery (P < .033).
Skepticism of Computer
Others are more skeptical about depending on a computer to determine
aesthetic success. Stephen Kroll, MD, professor of plastic surgery,
M.D. Anderson Cancer Center, is concerned that detailed computer
analyses fail to account for the role of the surgeons artistic
ability, skill, and dedication in reconstruction success and the
factors the patient herself considers when determining the success of
I think it would be a mistake if we leave this presentation
thinking that pedicle TRAMs give better results than free TRAMs,
Dr. Kroll said at a public forum held after the presentation. Dr.
Kroll said that his own observations regarding free and pedicle TRAM
procedures have not matched those of this study.
Dr. Wilkins does not dispute that the surgeons skill plays a
tremendous role in success. For that reason, the 12 centers and 24
surgeons participating in MBROS represent the full spectrum of
surgical settings, from small, private, single-physician practices to
large, urban academic hospitals. By separating the procedures
from the surgeons doing them, we are evaluating success more
realistically, Dr. Wilkins said. Not all women are going
to large, renowned academic hospitals for reconstruction procedures.
Dr. Wilkins does caution that these results are preliminary. So far,
MBROS has looked at approximately 400 patients. With larger
numbers, these findings could change, he concluded.
The Michigan Breast Reconstruction Outcome Study (MBROS) website for