Setting the Stage for Success: Evaluating Both Partner and Patient Satisfaction with Post-Mastectomy Breast Reconstruction

Setting the Stage for Success: Evaluating Both Partner and Patient Satisfaction with Post-Mastectomy Breast Reconstruction | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Setting the Stage for Success: Evaluating Both Partner and Patient Satisfaction with Post-Mastectomy Breast Reconstruction Sawyer Cimaroli, Miles Bichanich, Karri Adamson, John LoGiudice, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2015070/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Few studies have looked in-depth at the relationship between patient and partner satisfaction with post-mastectomy breast reconstruction. The studies that do exist suggest that perceived partner satisfaction is an important predictor of patient satisfaction in post-mastectomy breast reconstruction. Methods: We created a novel survey designed to look at reconstruction outcomes from a partner’s perspective. Patients with a history of mastectomy-alone or mastectomy with reconstruction at our institution from January 2011 through December 2020 were contacted electronically to complete a demographic form and the BREAST-Q©, while partners completed our novel partner survey. Sixteen mastectomy-only and 76 mastectomy with reconstruction couples completed surveys. Results: The mean Breast-Q© and partner survey scores were 87 and 87 (maximum possible=100) respectively for mastectomy with reconstruction. There was a correlation of 0.57 between patient and partner overall satisfaction. There was no difference in overall satisfaction between patients who underwent reconstruction and those who did not p=0.19. There was a relationship between satisfaction with pre-operative counseling and overall satisfaction in both patients and partners. The partner survey was found to have high internal consistency for measuring various areas of partner satisfaction. Conclusions: There is a relationship between patient and partner satisfaction with post-mastectomy breast reconstruction. Our data may support the positive impact of social support on recovery after breast cancer treatment, as satisfaction was high in both groups. We therefore encourage partners to attend and participate in pre-operative consultations. Finally, our novel partner survey is a reliable tool to assess partner satisfaction with post-mastectomy breast reconstruction. Breast cancer Breast reconstruction Mastectomy Patient satisfaction Partner satisfaction Figures Figure 1 Figure 2 Figure 3 Introduction The number of breast reconstructions performed in the United States annually has increased by 75% over a span of 20 years. 1 The increasing numbers of procedures has been appropriately met by increased research efforts aimed to improve patient outcomes. One research niche that has developed is that of investigating patient satisfaction and quality of life. Data born from these efforts shows that patients who chose to undergo breast reconstruction following mastectomy report improved sexual functioning, lower levels of depression, and improved body image compared to women who chose to not have breast reconstruction. 2 Additional work has uncovered several factors which impact patient satisfaction with post-mastectomy breast reconstruction. 3 , 4 One factor with impact that has not yet been fully interrogated is partner involvement and satisfaction. 4 Prior studies have investigated a wide variety of variables that contribute, both positively and negatively, to patient satisfaction following post-mastectomy breast reconstruction. 4 , 5 Several of these studies have suggested that perceived partner satisfaction is an important predictor of patient satisfaction. 4 , 6 ,7 Additional studies focused on the partners of the patients and the effects of the varying treatment modalities on their relationship satisfaction. 7 , 8 Broadly, several themes continued to reemerge throughout the literature: disappointment with preoperative counseling, avoidance of sexual contact postoperatively, and unsatisfactory postoperative communication between partners. 9 –13 In these studies, partners reported feeling ill-informed regarding post-operative appearance, hesitant to initiate sexual contact, uneasy discussing their partner’s post-operative body, and concern for their significant other’s health and well-being. 10 – 12 However, these studies have largely relied on open-ended questions, restricting the analyses to identification of common themes and qualitative data. In an attempt to quantitatively explore the relationship between patient and partner satisfaction with post-mastectomy breast reconstruction, in 2020 the authors conducted a couple-based survey using the BREAST-Q© and a novel partner survey. 14 Data from this study supported the presence of a relationship between overall patient and partner satisfaction with post-mastectomy breast reconstruction. 15 Despite the strong correlation, notable discrepancies existed between patient and partner, specifically with relation to post-operative sexual experience and understanding of appropriate post-operative expectations. 15 To further investigate the complex relationship between patient and partner experience, and ultimately satisfaction, with post-mastectomy breast reconstruction, we performed an extension of our pilot study, this time including both patients and partners who had undergone mastectomy alone or in combination with breast reconstruction. In congruence with historical work and our preliminary data, we expected to find a positive relationship between both choice to undergo reconstruction and partner satisfaction. Methods A single-center, cross-sectional survey of women who had mastectomy-alone or mastectomy with breast reconstruction performed by three plastic surgeons from January of 2011 through December of 2020, and their partners, was conducted. Women over the age of 18 with history of mastectomy for either cancer treatment or prophylaxis and who reported being in a relationship were contacted electronically to complete REDCap surveys. 16 , 17 Demographic data was self-reported and included: age, cancer stage, type of mastectomy and reconstruction, and surgical complications. Relationship data was self-reported and included: marital status, length of relationship, and sexuality. Participants took the BREAST-Q©, a validated procedure-specific questionnaire designed to measure patient satisfaction and quality of life. 14 Patients completed the postoperative BREAST-Q© module (Reconstruction or Mastectomy) as well as a series of questions regarding their perception of their partner’s satisfaction (Appendix 1). Partners completed a novel survey designed to assess satisfaction with their emotional relationship, partner’s reconstructed breasts/chest, partner’s medical care, and sexual relationship (Appendix 2). The questionnaires were designed based on common themes and questions that were the subject of prior partner-centered research. 9− 13 Couples were instructed to complete the questionnaires independently of one another and to not discuss answers until they had both completed the surveys. The BREAST-Q© and partner survey were scored from 0 to 100, with a higher score reflecting greater satisfaction. Descriptive statistics were used to analyze demographic data. A Pearson’s Correlation Coefficient was calculated to assess the strength of the relationship between patient satisfaction and partner satisfaction. One-way ANOVA was used to assess the relationship between partner satisfaction with information provided by the physician and overall satisfaction. Cronbach’s alpha was calculated for each sub-section of the novel partner survey to analyze internal consistency. Welch two-samples t-test was employed as a way to measure differences between mastectomy + reconstruction and mastectomy-alone satisfaction with various aspects of their care and outcomes. Institutional Review Board approval was obtained for this study. No reimbursement or incentives were given to couples for their participation in this study. Results Mastectomy with Reconstruction Nine hundred patients were electronically solicited to participate in the study. Seventy-six couples returned completed surveys (8% response rate). Participant demographic data is displayed in Table 1. The mean age of patients was 56.1 years and partners 57.8 years. The majority of patients were married (89%) with three patients who were divorced and five in a long-term relationship. The mean length of the relationships was 28 years (range 0.75-55). All couples in this portion of the study were heterosexual, although we did not specifically exclude other relationship orientations. All patients had completed their reconstruction and were no longer undergoing any active cancer treatments. Six (8%) of patients underwent prophylactic mastectomy with reconstruction because of a genetic predisposition (Table 1). The majority (57%) of patients had undergone bilateral mastectomy. Thirty-nine (51%) of the women had undergone tissue expander/implant-based reconstruction, while 36 (47%) had autologous reconstruction. Thirty-nine percent of patients had chemotherapy and 22% radiotherapy. The majority (74%) of patients reported no major complications with their reconstructive procedures. The mean overall satisfaction scores for mastectomy with reconstruction couples were 87 (range 32-100) and 87 (44-100) for patient and partner, respectively. There was no difference in satisfaction between patients who underwent tissue expander/implant based reconstruction and those who underwent autologous reconstruction. There was a correlation of 0.57 between patient and partner satisfaction with overall breast reconstruction, which is a moderate correlation (Figure 1).Forty-three percent (31) of partners report being afraid of causing pain if they initiated sexual contact, while 84% (64) of patients reported experiencing little to no pain. Twenty partners (29%) report that their partner’s breast reconstruction has had an effect on their frequency of sexual contact. Sixty percent (N=37) of patients agreed that having a third-party to facilitate conversation about post-reconstruction sexuality would be beneficial. Mean patient satisfaction with pre-operative information was 87 (range 30-100). There was a strong correlation of 0.82 between patient satisfaction with pre-operative counseling and overall satisfaction (Figure 2). There was a significant impact of satisfaction with pre-operative counseling on overall partner satisfaction as determined by one-way ANOVA (F(2,71) = 13.4, p = 0.00001). One of the sections within the BREAST-Q © is Satisfaction with Information. Patients indicate their satisfaction with various types of information which is ordinarily addressed during preoperative consultations. Questions within this section are scored on a Likert-Type scale (1-4) which ranges from “Very Dissatisfied” to “Very Satisfied”. All scores were high, as the mean score for satisfaction with information was 3.61, with a standard deviation of 0.19. However, within our patient population, there were four questions which patients reported lower satisfaction. The questions were: “What you could expect your breasts to look like after surgery?”, “How long after reconstruction surgery it would take to feel like yourself/feel normal again?”, “Lack of sensation in your reconstructed breast(s) and nipple(s)?”, and “What other women experience with their breast reconstruction surgery?” (Figure 3). The partner survey was tested for validity and found to have high internal consistency for measuring satisfaction with emotional relationship, partner’s breasts, partner’s medical care, and sexual relationship (Cronbach’s alpha= 0.90 , 0.96, 0.78, and 0.88). Mastectomy-Alone Two hundred sixty-three patients were contacted electronically to participate in the study. Sixteen couples returned completed surveys (6% response rate). The mean age of patients was 61.9 years and partners 64.1 years. The majority of patients were married (94%) with one patient in a long-term relationship. The mean length of the relationships was 37.4 years (range 10-64). One couple who participated in this portion of the study was homosexual, the remainder were heterosexual. None of the patients were undergoing any active cancer treatments at the time of survey. Two (13%) of patients opted to have prophylactic mastectomies because of a genetic predisposition. Seven (44%) of patients had unilateral mastectomies while the remaining nine (56%) underwent bilateral mastectomies. Fifty-six percent of patients were treated with chemotherapy and 31% with radiotherapy. There was no difference in mean patient or partner age between the mastectomy- alone and mastectomy with reconstruction groups (t(20)= -1.50, p= 0.14) and (t(20)=-1.56, p=0.13) respectively. The mean relationship length was longer in the mastectomy-alone group compared to the mastectomy with reconstruction (t(20)= -2.10, p= 0.05). There were no differences between the distribution of cancer staging between the two groups X 2 (5)= 6.54, p= 0.26. There was no difference in the distribution of unilateral vs bilateral mastectomy between groups X 2 (1)= 0.0006, p= 0.98. There was no difference in the proportion of patients who underwent chemotherapy or radiation between the groups X 2 (1)=1.52, p= 0.22 and X 2 (1)=0.57 , p= 0.45, respectively. Table 1: Patient Demographics Mastectomy-Alone Mastectomy with Reconstruction Patient Age (years) 61.9 (33-82) 56.1 (35-78) Partner Age (years) 64.1 (34-82) 57.8 (34-78) Relationship Length (years)* 37.4 (10-64) 27.6 (0.75-55) Cancer Stage Stage 0 Stage I Stage II Stage III Stage IV Genetic Predisposition 0 (0%) 5 (36%) 3 (21%) 2 (14%) 2 (14%) 2 (14%) 3 (4%) 37 (51%) 21 (29%) 4 (5%) 2 (3%) 6 (8%) Mastectomy Unilateral Bilateral 7 (44%) 9 (56%) 33 (43%) 43 (57%) Nipple Sparing Mastectomy** 0 16 (21%) Chemotherapy 9 (56%) 30 (39%) Radiation 5 (31%) 17 (22%) Type of Reconstruction Prosthetic, total (%) Autologous, total (%) Other, total (%) n/a n/a n/a 39 (51%) 36 (47%) 1 (1%) Table 1: Comparison of demographics between patients who underwent post-mastectomy breast reconstruction and those who underwent mastectomy alone. The mean overall satisfaction scores for mastectomy-only couples were 90 (77-100) and 90 (69-100) for patient and partner, respectively. The mean overall satisfaction scores were 87 (SD= 13) and 90 (SD= 7) for mastectomy with reconstruction and mastectomy-alone patients, respectively. A Welch two-samples t-test showed that there was no difference in overall satisfaction between patients who underwent reconstruction after their mastectomy and those who did not t(37.5)= -1.35, p=0.19, d=-0.31. The mean psychosocial well-being scores were 87 (SD= 19) and 87 (SD= 14) for mastectomy with reconstruction and mastectomy-alone patients, respectively. A Welch two-samples t-test showed that there was no difference in psychosocial satisfaction between patients who underwent reconstruction after their mastectomy and those who did not t(31.4)= 0.04, p= 0.96, d= 0.01. The mean sexual well-being score for patients who underwent breast reconstruction was 70 (SD= 24), while the mean score for patients who did not was 73 (SD= 24). A Welch two-samples t-test showed that there was no difference in sexual well-being between patients who underwent reconstruction after their mastectomy and those who did not t(19.8)= -0.47, p= 0.65, d= -0.17. The mean breast/chest satisfaction score for patients who underwent breast reconstruction was 83 (SD= 19), while the mean score for patients who did not was 79 (SD= 20). A Welch two-samples t-test showed that there was no difference in breast/chest satisfaction score between patients who underwent reconstruction after their mastectomy and those who did not t(21.1)= 0.77, p= 0.45, d= 0.22. Discussion Our data supports the notion that patient and partner satisfaction after breast cancer surgery is highly intertwined in a way that is unlikely to be related to the patient’s decision to undergo reconstruction or not. This is consistent with the findings of Spatuzzi and colleagues in their 2016 work evaluating the role of social support on body image and quality of life in women who have undergone various breast cancer treatments. 4 Their data support the importance of perceived social support after breast cancer surgery. 4 , 18 Therefore, while it is essential that decisions are made by, and in the best interest of, the patient, we encourage partners to take an active role in pre-operative consultations and discussions. Previous work has demonstrated that women who choose to undergo breast reconstruction following mastectomy, report higher satisfaction, as measured by the BREAST-Q©. 19 There are multiple, likely interdependent, explanations as to why our data did not support this well-established finding. First, regardless of the patient’s choice to undergo breast reconstruction or not, patients and their partners were overall very satisfied. Perhaps this finding highlights the positive impact of social support on recovery after treatment for breast cancer. 4 , 18 Further investigation into this topic is warranted and may include a comparison of patient satisfaction with a special consideration for relationship status and perceived social support. Patients and partners alike were more satisfied overall when they felt that they had been given sufficient information in the pre-operative period. The relationship between pre-operative education and patient body image was documented by Kuo and colleagues. 20 While patients in our study reported high overall satisfaction with pre-operative counseling, areas of perceived knowledge gaps existed. Specifically, patients felt less informed regarding others’ experiences with reconstruction, loss of sensation, emotional recovery time, and look of reconstructed breasts. This is congruent with prior data. 9 One resource that may be useful to patients and partners as they develop expectations for their reconstructed breasts, is the Before and After Photos page of American Society of Plastic Surgeons website. 21 Another area which has been shown to impact patient satisfaction with post-mastectomy breast reconstruction is post-operative sexuality. 11 Almost half of the partners surveyed in the reconstruction group reported experiencing fear of causing pain if they touched their partner’s reconstructed breasts. However, less than 20% of the patients reported experiencing pain in their reconstructed breasts. This discrepancy may be attributed to partner education. In spite of the fact that the majority of women in our study reported that their partner attended at least 75% of their appointments, knowledge gaps exist between patient and partner knowledge. One possible solution, first proposed by Rowland and Metcalfe, is information tailored to partners. 10 Based on other’s data as well as our own, we created a handout entitled, “Post-Mastectomy Breast Reconstruction: Tips for Supporting your Partner” which may be used as an additional resource for partners (Appendix 3). 15 , 18 , 20 , 22 Our current study demonstrates that our novel partner survey has an acceptable level of internal consistency, and thus, may be used as a viable option for assessing partner satisfaction with emotional relationship, partner’s breasts, partner’s medical care, and sexual relationship. One limitation of our study is the poor response rate from both groups. Another limitation of our study is the small sample size in the mastectomy-alone group. Satisfaction scores between mastectomy with reconstruction and mastectomy-alone patients in the present study did not differ significantly. This is in contrast to historical data. 2 Largely, women who chose to participate in our study were very satisfied with their post-mastectomy chest. It may be the case that only very satisfied patients and partners chose to participate in our study. Conclusions Following breast cancer surgery, a relationship exists between overall patient and partner satisfaction. Patients and partners alike, desire an understanding of not only their disease but also assistance in creating a framework for developing reasonable post-operative expectations. While the maintenance of patient autonomy is paramount, we encourage early and regular involvement of patients’ significant others when appropriate. Declarations Ethics approval and consent to participate- This study was approved by the Medical College of Wisconsin IRB review committee. All participants provided written informed consent to participate. Consent for publication- All authors consent to the publication of this manuscript. Availability of data and materials- Data and research material available upon request. Competing interests- None Funding- None Authors' contributions- S.C., M.B., and E.D. participated in writing the manuscript and preparing figures. All authors edited the manuscript. Acknowledgements- None Authors' information (optional)- None References ASPS. National Plastic Surgery Statistics. American Society of Plastic Surgeons. 2021. Archangelo SCV, Sabino Neto M, Veiga DF, Garcia EB, Ferreira LM. Sexuality, depression and body image after breast reconstruction. Clinics (Sao Paulo). 2019;74:e883. Matthews H, Carroll N, Renshaw D, et al. Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction. Psychooncology. 2017;26(11):1860-1865. Spatuzzi R, Vespa A, Lorenzi P, et al. Evaluation of Social Support, Quality of Life, and Body Image in Women with Breast Cancer. Breast Care (Basel). 2016;11(1):28-32. Spencer SM LJ, Wynings C, Arena P, Carver CS, Antoni MH, Derhagopian RP, Ironson G, Love N. . Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients. Health Psychology. 1999;18(2):159-168. Wimberly SR CC, Laurenceau JP, Harris SD, Antoni MH. Perceived partner reactions to diagnosis and treatment of breast cancer: impact on psychosocial and psychosexual adjustment. J Consult Clin Psychol. 2005;73(2):300-311. Zimmermann T SJ, Heinrichs N. . Individual and dyadic predictors of body image in women with breast cancer. . Psychooncology 2010;19(10):1061-1068. Holmberg SK SL, Alexy W, Fife BL. . Relationship Issues of Women with Breast Cancer. Cancer Nursing. 2001;24(1):53-60. Cohen WA, Ballard TN, Hamill JB, et al. Understanding and Optimizing the Patient Experience in Breast Reconstruction. Ann Plast Surg. 2016;77(2):237-241. Rowland E, Metcalfe A. A systematic review of men's experiences of their partner's mastectomy: coping with altered bodies. Psychooncology. 2014;23(9):963-974. Loaring JM, Larkin M, Shaw R, Flowers P. Renegotiating sexual intimacy in the context of altered embodiment: the experiences of women with breast cancer and their male partners following mastectomy and reconstruction. Health Psychology. 2015;34(4):426-436. Sandham C, Harcourt D. Partner experiences of breast reconstruction post mastectomy. European Journal of Oncology Nursing. 2006;11(1):66-73. Marshall CA, & Kiemle, G. Breast reconstruction following cancer: Its impact on patients' and partners' sexual functioning. Sexual and Relationship Therapy. 2005;20:155-179. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a New Patient-Reported Outcome Measure for Breast Surgery: The BREAST-Q. Plastic and Reconstructive Surgery. 2009;124(2):345-353. Cimaroli S, LoGiudice JA, Doren EL. Exploring the Role of Partner Satisfaction in Predicting Patient Satisfaction Regarding Post-mastectomy Breast Reconstruction. Plast Reconstr Surg Glob Open. 2020;8(7):e2943. PA Harris RT, R Thielke, J Payne, N Gonzalez, JG. Conde. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support,. J Biomed Inform. 2009;42:377-381. PA Harris RT, BL Minor, V Elliott, M Fernandez, L O’Neal, L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda. REDCap Consortium, The REDCap consortium: Building an international community of software partners. J Biomed Inform. 2019;95:1-10. Baucom D, Porter L, Kirby J, Gremore T, Keefe F. Psychosocial issues confronting young women with breast cancer. Breast Disease. 2005-2006;23:103-113. Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q. Plast Reconstr Surg. 2017;139(5):1046e-1055e. Kuo NT, Kuo YL, Lai HW, Ko NY, Fang SY. The influence of partner involvement in the decision-making process on body image and decision regret among women receiving breast reconstruction. Support Care Cancer. 2019;27(5):1721-1728. ASPS. American Society of Plastic Surgeons. Breast Reconstruction Before and After Photos Web site. https://www.plasticsurgery.org/photo-gallery/procedure/breast-reconstruction. Published 2021. Accessed. Shridharani SM, Magarakis M, Stapleton SM, Basdag B, Seal SM, Rosson GD. Breast sensation after breast reconstruction: a systematic review. J Reconstr Microsurg. 2010;26(5):303-310. Additional Declarations No competing interests reported. Supplementary Files AppendicesPatientPartnerSatisfaction.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2015070","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":136632273,"identity":"dfbd97f7-7afc-4f87-9ea0-37e7f92795f4","order_by":0,"name":"Sawyer Cimaroli","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYBADHjD5wMAGSDI2HiBeS4JBGkhLA1FaICCB4TCYxqtFvv2MmcTHPXYyuu1nHz5IKDhvt7b9MNCWGptoXFoMzuSYSc54lsxjdibd2CDB4HbytjOJQC3H0nIbcGlhyN0mzXPgAI/ZgTQ2CZAWswNALYwNh3Fqke9/u036D0jL+WcgLeeSzc4/xK+F4QbQFgaQlhtgWw7Ymd0gYIvBjfefLXsOAP1y4xkz0C/JCWY3gLYk4PGLfH9a4o0fB+zszc6nMT748AfESH/44EONDW6HMTCwSCDzEsEqE3ArBwHmD8g8e/yKR8EoGAWjYCQCANgQZMDnN6imAAAAAElFTkSuQmCC","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Sawyer","middleName":"","lastName":"Cimaroli","suffix":""},{"id":136632274,"identity":"3760bf71-06a0-4870-ab40-6c54652e3205","order_by":1,"name":"Miles Bichanich","email":"","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Miles","middleName":"","lastName":"Bichanich","suffix":""},{"id":136632275,"identity":"079d9f10-6c3b-451b-a6d0-f0cecf19fb54","order_by":2,"name":"Karri Adamson","email":"","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Karri","middleName":"","lastName":"Adamson","suffix":""},{"id":136632276,"identity":"6a9c5bac-09ab-4f7a-9a37-413e976a8939","order_by":3,"name":"John LoGiudice","email":"","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"LoGiudice","suffix":""},{"id":136632277,"identity":"42e730db-abca-4a31-a14b-a26c094eac13","order_by":4,"name":"Erin Doren","email":"","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Erin","middleName":"","lastName":"Doren","suffix":""}],"badges":[],"createdAt":"2022-08-30 18:29:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2015070/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2015070/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":26580188,"identity":"9474e1db-3c7a-45d2-8e5d-81c277b4b70a","added_by":"auto","created_at":"2022-09-16 20:49:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":117293,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between overall patient and partner satisfaction scores Pearson’s Correlation Coefficient = 0.57.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2015070/v1/b436166b7dc6980e584384c6.png"},{"id":26579173,"identity":"5b63bdd6-0e26-410e-80d3-9b5dd4d38bc0","added_by":"auto","created_at":"2022-09-16 20:44:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":124215,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between overall patient satisfaction and satisfaction with pre-operative information provided. Pearson’s Correlation Coefficient = 0.82.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2015070/v1/c55483165707bd5fa149056a.png"},{"id":26579175,"identity":"ad5dc296-ce77-4459-9ce3-fcca37fd3e61","added_by":"auto","created_at":"2022-09-16 20:44:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":158677,"visible":true,"origin":"","legend":"\u003cp\u003ePossible areas for improvement in pre-operative counseling. Patients reported satisfaction by selecting a score 1-4. Scores of 1 indicate a patient was very dissatisfied, which scores of 4 indicate that a patient was very satisfied.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-2015070/v1/50ae51fcf02cb9a24b52f652.png"},{"id":30996275,"identity":"35b8c5ec-1bd9-4904-ae03-8c76172e273e","added_by":"auto","created_at":"2023-01-03 02:14:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":655413,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2015070/v1/00899f29-204f-48b0-bc69-ccf40a51c4cd.pdf"},{"id":26579176,"identity":"5798b454-27c8-430b-a87d-f3b331dff151","added_by":"auto","created_at":"2022-09-16 20:44:49","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1254018,"visible":true,"origin":"","legend":"","description":"","filename":"AppendicesPatientPartnerSatisfaction.docx","url":"https://assets-eu.researchsquare.com/files/rs-2015070/v1/eeb56f1b4d5e3ea26cf40fdb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Setting the Stage for Success: Evaluating Both Partner and Patient Satisfaction with Post-Mastectomy Breast Reconstruction","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe number of breast reconstructions performed in the United States annually has increased by 75% over a span of 20 years.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The increasing numbers of procedures has been appropriately met by increased research efforts aimed to improve patient outcomes. One research niche that has developed is that of investigating patient satisfaction and quality of life. Data born from these efforts shows that patients who chose to undergo breast reconstruction following mastectomy report improved sexual functioning, lower levels of depression, and improved body image compared to women who chose to not have breast reconstruction.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Additional work has uncovered several factors which impact patient satisfaction with post-mastectomy breast reconstruction.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e One factor with impact that has not yet been fully interrogated is partner involvement and satisfaction.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePrior studies have investigated a wide variety of variables that contribute, both positively and negatively, to patient satisfaction following post-mastectomy breast reconstruction.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Several of these studies have suggested that perceived partner satisfaction is an important predictor of patient satisfaction.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,7\u003c/sup\u003eAdditional studies focused on the partners of the patients and the effects of the varying treatment modalities on their relationship satisfaction.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Broadly, several themes continued to reemerge throughout the literature: disappointment with preoperative counseling, avoidance of sexual contact postoperatively, and unsatisfactory postoperative communication between partners.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;13\u003c/sup\u003eIn these studies, \u003cem\u003epartners\u003c/em\u003e reported feeling ill-informed regarding post-operative appearance, hesitant to initiate sexual contact, uneasy discussing their partner\u0026rsquo;s post-operative body, and concern for their significant other\u0026rsquo;s health and well-being.\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e However, these studies have largely relied on open-ended questions, restricting the analyses to identification of common themes and qualitative data.\u003c/p\u003e \u003cp\u003eIn an attempt to quantitatively explore the relationship between patient and partner satisfaction with post-mastectomy breast reconstruction, in 2020 the authors conducted a couple-based survey using the BREAST-Q\u0026copy; and a novel partner survey.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Data from this study supported the presence of a relationship between overall patient and partner satisfaction with post-mastectomy breast reconstruction.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Despite the strong correlation, notable discrepancies existed between patient and partner, specifically with relation to post-operative sexual experience and understanding of appropriate post-operative expectations.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTo further investigate the complex relationship between patient and partner experience, and ultimately satisfaction, with post-mastectomy breast reconstruction, we performed an extension of our pilot study, this time including both patients and partners who had undergone mastectomy alone or in combination with breast reconstruction. In congruence with historical work and our preliminary data, we expected to find a positive relationship between both choice to undergo reconstruction and partner satisfaction.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA single-center, cross-sectional survey of women who had mastectomy-alone or mastectomy with breast reconstruction performed by three plastic surgeons from January of 2011 through December of 2020, and their partners, was conducted. Women over the age of 18 with history of mastectomy for either cancer treatment or prophylaxis and who reported being in a relationship were contacted electronically to complete REDCap surveys.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Demographic data was self-reported and included: age, cancer stage, type of mastectomy and reconstruction, and surgical complications. Relationship data was self-reported and included: marital status, length of relationship, and sexuality.\u003c/p\u003e \u003cp\u003eParticipants took the BREAST-Q\u0026copy;, a validated procedure-specific questionnaire designed to measure patient satisfaction and quality of life.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Patients completed the postoperative BREAST-Q\u0026copy; module (Reconstruction or Mastectomy) as well as a series of questions regarding their perception of their partner\u0026rsquo;s satisfaction (Appendix 1). Partners completed a novel survey designed to assess satisfaction with their emotional relationship, partner\u0026rsquo;s reconstructed breasts/chest, partner\u0026rsquo;s medical care, and sexual relationship (Appendix 2). The questionnaires were designed based on common themes and questions that were the subject of prior partner-centered research.\u003csup\u003e9\u0026minus;\u0026thinsp;13\u003c/sup\u003e Couples were instructed to complete the questionnaires independently of one another and to not discuss answers until they had both completed the surveys. The BREAST-Q\u0026copy; and partner survey were scored from 0 to 100, with a higher score reflecting greater satisfaction.\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to analyze demographic data. A Pearson\u0026rsquo;s Correlation Coefficient was calculated to assess the strength of the relationship between patient satisfaction and partner satisfaction. One-way ANOVA was used to assess the relationship between partner satisfaction with information provided by the physician and overall satisfaction. Cronbach\u0026rsquo;s alpha was calculated for each sub-section of the novel partner survey to analyze internal consistency. Welch two-samples t-test was employed as a way to measure differences between mastectomy\u0026thinsp;+\u0026thinsp;reconstruction and mastectomy-alone satisfaction with various aspects of their care and outcomes.\u003c/p\u003e \u003cp\u003e Institutional Review Board approval was obtained for this study. No reimbursement or incentives were given to couples for their participation in this study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eMastectomy with Reconstruction\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNine hundred patients were electronically solicited to participate in the study. Seventy-six couples returned completed surveys (8% response rate). Participant demographic data is displayed in Table 1. The mean age of patients was 56.1 years and partners 57.8 years. \u0026nbsp;The majority of patients were married (89%) with three patients who were divorced and five in a long-term relationship. The mean length of the relationships was 28 years (range 0.75-55). All couples in this portion of the study were heterosexual, although we did not specifically exclude other relationship orientations.\u003c/p\u003e\n\u003cp\u003eAll patients had completed their reconstruction and were no longer undergoing any active cancer treatments. Six (8%) of patients underwent prophylactic mastectomy with reconstruction because of a genetic predisposition (Table 1). The majority (57%) of patients had undergone bilateral mastectomy. Thirty-nine (51%) of the women had undergone tissue expander/implant-based reconstruction, while 36 (47%) had autologous reconstruction. Thirty-nine percent of patients had chemotherapy and 22% radiotherapy. The majority (74%) of patients reported no major complications with their reconstructive procedures.\u003c/p\u003e\n\u003cp\u003eThe mean overall satisfaction scores for mastectomy with reconstruction couples were 87 (range 32-100) and 87 (44-100) for patient and partner, respectively. There was no difference in satisfaction between patients who underwent tissue expander/implant based reconstruction and those who underwent autologous reconstruction. There was a correlation of 0.57 between patient and partner satisfaction with overall breast reconstruction, which is a moderate correlation (Figure 1).Forty-three percent (31) of partners report being afraid of causing pain if they initiated sexual contact, while 84% (64) of patients reported experiencing little to no pain. Twenty partners (29%) report that their partner\u0026rsquo;s breast reconstruction has had an effect on their frequency of sexual contact. Sixty percent (N=37) of patients agreed that having a third-party to facilitate conversation about post-reconstruction sexuality would be beneficial.\u003c/p\u003e\n\u003cp\u003eMean patient satisfaction with pre-operative information was 87 (range 30-100). There was a strong correlation of 0.82 between patient satisfaction with pre-operative counseling and overall satisfaction (Figure 2). There was a significant impact of satisfaction with pre-operative counseling on overall partner satisfaction as determined by one-way ANOVA (F(2,71) = 13.4, \u0026nbsp;p = 0.00001).\u003c/p\u003e\n\u003cp\u003eOne of the sections within the BREAST-Q\u003csup\u003e\u0026copy;\u003c/sup\u003e is \u003cem\u003eSatisfaction with Information.\u0026nbsp;\u003c/em\u003ePatients indicate their satisfaction with various types of information which is ordinarily addressed during preoperative consultations. Questions within this section are scored on a Likert-Type scale (1-4) which ranges from \u0026ldquo;Very Dissatisfied\u0026rdquo; to \u0026ldquo;Very Satisfied\u0026rdquo;. All scores were high, as the mean score for satisfaction with information was 3.61, with a standard deviation of 0.19. However, within our patient population, there were four questions which patients reported lower satisfaction. The questions were: \u0026ldquo;What you could expect your breasts to look like after surgery?\u0026rdquo;, \u0026ldquo;How long after reconstruction surgery it would take to feel like yourself/feel normal again?\u0026rdquo;, \u0026ldquo;Lack of sensation in your reconstructed breast(s) and nipple(s)?\u0026rdquo;, and \u0026ldquo;What other women experience with their breast reconstruction surgery?\u0026rdquo; (Figure 3).\u003c/p\u003e\n\u003cp\u003eThe partner survey was tested for validity and found to have high internal consistency for measuring satisfaction with emotional relationship,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003epartner\u0026rsquo;s breasts, partner\u0026rsquo;s medical care,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eand sexual relationship (Cronbach\u0026rsquo;s alpha= 0.90\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003e0.96, 0.78, and 0.88).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMastectomy-Alone\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTwo hundred sixty-three patients were contacted electronically to participate in the study. Sixteen couples returned completed surveys (6% response rate). The mean age of patients was 61.9 years and partners 64.1 years. \u0026nbsp;The majority of patients were married (94%) with one patient in a long-term relationship. The mean length of the relationships was 37.4 years (range 10-64). One couple who participated in this portion of the study was homosexual, the remainder were heterosexual. None of the patients were undergoing any active cancer treatments at the time of survey. Two (13%) of patients opted to have prophylactic mastectomies because of a genetic predisposition. Seven (44%) of patients had unilateral mastectomies while the remaining nine (56%) underwent bilateral mastectomies. Fifty-six percent of patients were treated with chemotherapy and 31% with radiotherapy.\u003c/p\u003e\n\u003cp\u003eThere was no difference in mean patient or partner age between the mastectomy- alone and mastectomy with reconstruction groups (t(20)= -1.50, p= 0.14) and (t(20)=-1.56, p=0.13) respectively. The mean relationship length was longer in the mastectomy-alone group compared to the mastectomy with reconstruction (t(20)= -2.10, p= 0.05). There were no differences between the distribution of cancer staging between the two groups X\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e(5)= 6.54, p= 0.26. There was no difference in the distribution of unilateral vs bilateral mastectomy between groups X\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e(1)= 0.0006, p= 0.98. There was no difference in the proportion of patients who underwent chemotherapy or radiation between the groups X\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e(1)=1.52, p= 0.22 and X\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e(1)=0.57 , p= 0.45, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Patient Demographics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"41.34615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMastectomy-Alone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMastectomy with Reconstruction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"41.34615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Age (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e61.9 (33-82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e56.1 (35-78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"41.34615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartner Age (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e64.1 (34-82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e57.8 (34-78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"41.34615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelationship Length (years)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e37.4 (10-64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e27.6 (0.75-55)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"41.34615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Stage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eStage 0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eStage I\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eStage II\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eStage III\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eStage IV\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGenetic Predisposition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e5 (36%)\u003c/p\u003e\n \u003cp\u003e3 (21%)\u003c/p\u003e\n \u003cp\u003e2 (14%)\u003c/p\u003e\n \u003cp\u003e2 (14%)\u003c/p\u003e\n \u003cp\u003e2 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (4%)\u003c/p\u003e\n \u003cp\u003e37 (51%)\u003c/p\u003e\n \u003cp\u003e21 (29%)\u003c/p\u003e\n \u003cp\u003e4 (5%)\u003c/p\u003e\n \u003cp\u003e2 (3%)\u003c/p\u003e\n \u003cp\u003e6 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"41.34615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMastectomy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eUnilateral\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (44%)\u003c/p\u003e\n \u003cp\u003e9 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 (43%)\u003c/p\u003e\n \u003cp\u003e43 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"41.34615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNipple Sparing Mastectomy**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e16 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"41.34615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003eChemotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e9 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e30 (39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"41.34615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e5 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e17 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"41.34615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Reconstruction\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eProsthetic, total (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAutologous, total (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOther, total (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (51%)\u003c/p\u003e\n \u003cp\u003e36 (47%)\u003c/p\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1: \u003cem\u003eComparison of demographics between patients who underwent post-mastectomy breast reconstruction and those who underwent mastectomy alone.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe mean overall satisfaction scores for mastectomy-only couples were 90 (77-100) and 90 (69-100) for patient and partner, respectively.\u003c/p\u003e\n\u003cp\u003eThe mean overall satisfaction scores were 87 (SD= 13) and 90 (SD= 7) for mastectomy with reconstruction and mastectomy-alone patients, respectively. \u0026nbsp; A Welch two-samples t-test showed that there was no difference in overall satisfaction between patients who underwent reconstruction after their mastectomy and those who did not t(37.5)= -1.35, p=0.19, d=-0.31.\u003c/p\u003e\n\u003cp\u003eThe mean psychosocial well-being scores were 87 (SD= 19) and 87 (SD= 14) for mastectomy with reconstruction and mastectomy-alone patients, respectively. A Welch two-samples t-test showed that there was no difference in psychosocial satisfaction between patients who underwent reconstruction after their mastectomy and those who did not t(31.4)= 0.04, p= 0.96, d= 0.01.\u003c/p\u003e\n\u003cp\u003eThe mean sexual well-being score for patients who underwent breast reconstruction was 70 (SD= 24), while the mean score for patients who did not was 73 (SD= 24). A Welch two-samples t-test showed that there was no difference in sexual well-being between patients who underwent reconstruction after their mastectomy and those who did not t(19.8)= -0.47, p= 0.65, d= -0.17.\u003c/p\u003e\n\u003cp\u003eThe mean breast/chest satisfaction score for patients who underwent breast reconstruction was 83 (SD= 19), while the mean score for patients who did not was 79 (SD= 20). A Welch two-samples t-test showed that there was no difference in breast/chest satisfaction score between patients who underwent reconstruction after their mastectomy and those who did not t(21.1)= 0.77, p= 0.45, d= 0.22.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur data supports the notion that patient and partner satisfaction after breast cancer surgery is highly intertwined in a way that is unlikely to be related to the patient\u0026rsquo;s decision to undergo reconstruction or not. This is consistent with the findings of Spatuzzi and colleagues in their 2016 work evaluating the role of social support on body image and quality of life in women who have undergone various breast cancer treatments.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Their data support the importance of perceived social support after breast cancer surgery.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Therefore, while it is essential that decisions are made by, and in the best interest of, the patient, we encourage partners to take an active role in pre-operative consultations and discussions.\u003c/p\u003e \u003cp\u003ePrevious work has demonstrated that women who choose to undergo breast reconstruction following mastectomy, report higher satisfaction, as measured by the BREAST-Q\u0026copy;.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e There are multiple, likely interdependent, explanations as to why our data did not support this well-established finding. First, regardless of the patient\u0026rsquo;s choice to undergo breast reconstruction or not, patients and their partners were overall very satisfied. Perhaps this finding highlights the positive impact of social support on recovery after treatment for breast cancer.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Further investigation into this topic is warranted and may include a comparison of patient satisfaction with a special consideration for relationship status and perceived social support.\u003c/p\u003e \u003cp\u003ePatients and partners alike were more satisfied overall when they felt that they had been given sufficient information in the pre-operative period. The relationship between pre-operative education and patient body image was documented by Kuo and colleagues.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e While patients in our study reported high overall satisfaction with pre-operative counseling, areas of perceived knowledge gaps existed. Specifically, patients felt less informed regarding others\u0026rsquo; experiences with reconstruction, loss of sensation, emotional recovery time, and look of reconstructed breasts. This is congruent with prior data.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e One resource that may be useful to patients and partners as they develop expectations for their reconstructed breasts, is the Before and After Photos page of \u003cem\u003eAmerican Society of Plastic Surgeons\u003c/em\u003e website.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAnother area which has been shown to impact patient satisfaction with post-mastectomy breast reconstruction is post-operative sexuality.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Almost half of the partners surveyed in the reconstruction group reported experiencing fear of causing pain if they touched their partner\u0026rsquo;s reconstructed breasts. However, less than 20% of the patients reported experiencing pain in their reconstructed breasts. This discrepancy may be attributed to partner education. In spite of the fact that the majority of women in our study reported that their partner attended at least 75% of their appointments, knowledge gaps exist between patient and partner knowledge. One possible solution, first proposed by Rowland and Metcalfe, is information tailored to partners.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Based on other\u0026rsquo;s data as well as our own, we created a handout entitled, \u0026ldquo;Post-Mastectomy Breast Reconstruction: Tips for Supporting your Partner\u0026rdquo; which may be used as an additional resource for partners (Appendix 3).\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur current study demonstrates that our novel partner survey has an acceptable level of internal consistency, and thus, may be used as a viable option for assessing partner satisfaction with emotional relationship, partner\u0026rsquo;s breasts, partner\u0026rsquo;s medical care, and sexual relationship.\u003c/p\u003e \u003cp\u003eOne limitation of our study is the poor response rate from both groups. Another limitation of our study is the small sample size in the mastectomy-alone group. Satisfaction scores between mastectomy with reconstruction and mastectomy-alone patients in the present study did not differ significantly. This is in contrast to historical data.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Largely, women who chose to participate in our study were very satisfied with their post-mastectomy chest. It may be the case that only very satisfied patients and partners chose to participate in our study.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eFollowing breast cancer surgery, a relationship exists between overall patient and partner satisfaction. Patients and partners alike, desire an understanding of not only their disease but also assistance in creating a framework for developing reasonable post-operative expectations. While the maintenance of patient autonomy is paramount, we encourage early and regular involvement of patients\u0026rsquo; significant others when appropriate.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate- This study was approved by the Medical College of Wisconsin IRB review committee. All participants provided written informed consent to participate. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication- All authors consent to the publication of this manuscript.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials- Data and research material available upon request.\u003c/p\u003e\n\u003cp\u003eCompeting interests- None\u003c/p\u003e\n\u003cp\u003eFunding- None\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions- S.C., M.B., and E.D. participated in writing the manuscript and preparing figures. All authors edited the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements- None\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information (optional)- None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eASPS. National Plastic Surgery Statistics. \u003cem\u003eAmerican Society of Plastic Surgeons.\u0026nbsp;\u003c/em\u003e2021.\u003c/li\u003e\n \u003cli\u003eArchangelo SCV, Sabino Neto M, Veiga DF, Garcia EB, Ferreira LM. Sexuality, depression and body image after breast reconstruction. \u003cem\u003eClinics (Sao Paulo).\u0026nbsp;\u003c/em\u003e2019;74:e883.\u003c/li\u003e\n \u003cli\u003eMatthews H, Carroll N, Renshaw D, et al. Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction. \u003cem\u003ePsychooncology.\u0026nbsp;\u003c/em\u003e2017;26(11):1860-1865.\u003c/li\u003e\n \u003cli\u003eSpatuzzi R, Vespa A, Lorenzi P, et al. Evaluation of Social Support, Quality of Life, and Body Image in Women with Breast Cancer. \u003cem\u003eBreast Care (Basel).\u0026nbsp;\u003c/em\u003e2016;11(1):28-32.\u003c/li\u003e\n \u003cli\u003eSpencer SM LJ, Wynings C, Arena P, Carver CS, Antoni MH, Derhagopian RP, Ironson G, Love N. . Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients. \u003cem\u003eHealth Psychology.\u0026nbsp;\u003c/em\u003e1999;18(2):159-168.\u003c/li\u003e\n \u003cli\u003eWimberly SR CC, Laurenceau JP, Harris SD, Antoni MH. Perceived partner reactions to diagnosis and treatment of breast cancer: impact on psychosocial and psychosexual adjustment. \u003cem\u003eJ Consult Clin Psychol.\u0026nbsp;\u003c/em\u003e2005;73(2):300-311.\u003c/li\u003e\n \u003cli\u003eZimmermann T SJ, Heinrichs N. . Individual and dyadic predictors of body image in women with breast cancer. . \u003cem\u003ePsychooncology\u0026nbsp;\u003c/em\u003e2010;19(10):1061-1068.\u003c/li\u003e\n \u003cli\u003eHolmberg SK SL, Alexy W, Fife BL. . Relationship Issues of Women with Breast Cancer. \u003cem\u003eCancer Nursing.\u0026nbsp;\u003c/em\u003e2001;24(1):53-60.\u003c/li\u003e\n \u003cli\u003eCohen WA, Ballard TN, Hamill JB, et al. Understanding and Optimizing the Patient Experience in Breast Reconstruction. \u003cem\u003eAnn Plast Surg.\u0026nbsp;\u003c/em\u003e2016;77(2):237-241.\u003c/li\u003e\n \u003cli\u003eRowland E, Metcalfe A. A systematic review of men\u0026apos;s experiences of their partner\u0026apos;s mastectomy: coping with altered bodies. \u003cem\u003ePsychooncology.\u0026nbsp;\u003c/em\u003e2014;23(9):963-974.\u003c/li\u003e\n \u003cli\u003eLoaring JM, Larkin M, Shaw R, Flowers P. Renegotiating sexual intimacy in the context of altered embodiment: the experiences of women with breast cancer and their male partners following mastectomy and reconstruction. \u003cem\u003eHealth Psychology.\u0026nbsp;\u003c/em\u003e2015;34(4):426-436.\u003c/li\u003e\n \u003cli\u003eSandham C, Harcourt D. Partner experiences of breast reconstruction post mastectomy. \u003cem\u003eEuropean Journal of Oncology Nursing.\u0026nbsp;\u003c/em\u003e2006;11(1):66-73.\u003c/li\u003e\n \u003cli\u003eMarshall CA, \u0026amp; Kiemle, G. Breast reconstruction following cancer: Its impact on patients\u0026apos; and partners\u0026apos; sexual functioning. \u003cem\u003eSexual and Relationship Therapy.\u0026nbsp;\u003c/em\u003e2005;20:155-179.\u003c/li\u003e\n \u003cli\u003ePusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a New Patient-Reported Outcome Measure for Breast Surgery: The BREAST-Q. \u003cem\u003ePlastic and Reconstructive Surgery.\u0026nbsp;\u003c/em\u003e2009;124(2):345-353.\u003c/li\u003e\n \u003cli\u003eCimaroli S, LoGiudice JA, Doren EL. Exploring the Role of Partner Satisfaction in Predicting Patient Satisfaction Regarding Post-mastectomy Breast Reconstruction. \u003cem\u003ePlast Reconstr Surg Glob Open.\u0026nbsp;\u003c/em\u003e2020;8(7):e2943.\u003c/li\u003e\n \u003cli\u003ePA Harris RT, R Thielke, J Payne, N Gonzalez, JG. Conde. Research electronic data capture (REDCap) \u0026ndash; A metadata-driven methodology and workflow process for providing translational research informatics support,. \u003cem\u003eJ Biomed Inform.\u0026nbsp;\u003c/em\u003e2009;42:377-381.\u003c/li\u003e\n \u003cli\u003ePA Harris RT, BL Minor, V Elliott, M Fernandez, L O\u0026rsquo;Neal, L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda. REDCap Consortium, The REDCap consortium: Building an international community of software partners. \u003cem\u003eJ Biomed Inform.\u0026nbsp;\u003c/em\u003e2019;95:1-10.\u003c/li\u003e\n \u003cli\u003eBaucom D, Porter L, Kirby J, Gremore T, Keefe F. Psychosocial issues confronting young women with breast cancer. \u003cem\u003eBreast Disease.\u0026nbsp;\u003c/em\u003e2005-2006;23:103-113.\u003c/li\u003e\n \u003cli\u003eMundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q. \u003cem\u003ePlast Reconstr Surg.\u0026nbsp;\u003c/em\u003e2017;139(5):1046e-1055e.\u003c/li\u003e\n \u003cli\u003eKuo NT, Kuo YL, Lai HW, Ko NY, Fang SY. The influence of partner involvement in the decision-making process on body image and decision regret among women receiving breast reconstruction. \u003cem\u003eSupport Care Cancer.\u0026nbsp;\u003c/em\u003e2019;27(5):1721-1728.\u003c/li\u003e\n \u003cli\u003eASPS. American Society of Plastic Surgeons. Breast Reconstruction Before and After Photos Web site. https://www.plasticsurgery.org/photo-gallery/procedure/breast-reconstruction. Published 2021. Accessed.\u003c/li\u003e\n \u003cli\u003eShridharani SM, Magarakis M, Stapleton SM, Basdag B, Seal SM, Rosson GD. Breast sensation after breast reconstruction: a systematic review. \u003cem\u003eJ Reconstr Microsurg.\u0026nbsp;\u003c/em\u003e2010;26(5):303-310.\u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Breast reconstruction, Mastectomy, Patient satisfaction, Partner satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-2015070/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2015070/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Few studies have looked in-depth at the relationship between patient and partner satisfaction with post-mastectomy breast reconstruction. The studies that do exist suggest that perceived partner satisfaction is an important predictor of patient satisfaction in post-mastectomy breast reconstruction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We created a novel survey designed to look at reconstruction outcomes from a partner’s perspective. Patients with a history of mastectomy-alone or mastectomy with reconstruction at our institution from January 2011 through December 2020 were contacted electronically to complete a demographic form and the BREAST-Q©, while partners completed our novel partner survey. Sixteen mastectomy-only and 76 mastectomy with reconstruction couples completed surveys.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The mean Breast-Q© and partner survey scores were 87 and 87 (maximum possible=100) respectively for mastectomy with reconstruction. There was a correlation of 0.57 between patient and partner overall satisfaction. There was no difference in overall satisfaction between patients who underwent reconstruction and those who did not p=0.19. There was a relationship between satisfaction with pre-operative counseling and overall satisfaction in both patients and partners. The partner survey was found to have high internal consistency for measuring various areas of partner satisfaction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e There is a relationship between patient and partner satisfaction with post-mastectomy breast reconstruction. Our data may support the positive impact of social support on recovery after breast cancer treatment, as satisfaction was high in both groups. We therefore encourage partners to attend and participate in pre-operative consultations. Finally, our novel partner survey is a reliable tool to assess partner satisfaction with post-mastectomy breast reconstruction.\u003c/p\u003e","manuscriptTitle":"Setting the Stage for Success: Evaluating Both Partner and Patient Satisfaction with Post-Mastectomy Breast Reconstruction","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-16 20:44:47","doi":"10.21203/rs.3.rs-2015070/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d1795d4-bd93-408b-aee4-9bea75e21339","owner":[],"postedDate":"September 16th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-01-03T02:14:18+00:00","versionOfRecord":[],"versionCreatedAt":"2022-09-16 20:44:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2015070","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2015070","identity":"rs-2015070","version":["v1"]},"buildId":"pf3fE39SIOqb-0xH_OWvX","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}