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Do patient-reported outcome measures differ among clinical T4 patients undergoing mastectomy with and without reconstruction?Neither reconstruction nor timing of reconstruction were associated with superior outcomes for breast satisfaction, physical well-being of the chest, or psychosocial well-being at any timepoint.

Patients with clinical T4M0 breast cancer are recommended to undergo neoadjuvant chemotherapy, modified radical mastectomy, and postmastectomy radiotherapy. This study determined whether BREAST-Q scores differ by decision to pursue reconstruction or timing of reconstruction.This retrospective, single-institutional study analyzed cT4 breast cancer patients from 2014 to 2021 without evidence of distant metastatic disease undergoing mastectomy with or without reconstruction. As routine care, BREAST-Q was administered preoperatively, then 6 months, 1 year, and 2 years postoperatively. Satisfaction and quality-of-life domains were compared between mastectomy with no reconstruction (NR), immediate reconstruction (IR), and delayed reconstruction (DR) groups.Of the 144 patients eligible for this study, 71 (49%) had NR, 36 (25%) had DR, and 37 (26%) had IR. The patients undergoing reconstruction were younger and more likely to elect contralateral prophylactic mastectomy. Timing of reconstruction was not associated with significant differences in satisfaction with breasts (SATBR) at any time point. For the patients who had DR, breast satisfaction increased over time after reconstructive surgery. Physical well-being of the chest (PWB-CHEST) did not significantly differ among IR, DR, and NR at any time point. The patients who underwent DR experienced improvement in PWB-CHEST scores from preoperative scores. The patients with IR and NR experienced PWB-CHEST decline over time. Psychosocial well-being (PSWB) did not differ significantly across time or by subgroup.The patients with T4 breast cancer who elected reconstruction did not differ in patient-reported outcomes based on timing of reconstruction. In the DR cohort, SATBR significantly improved after reconstructive surgery. These data can help inform breast reconstructive decision-making for patients facing the choice among DR, IR, and NR.

Objective The purpose of this study was to synthesize surgical education research literature over the last decade and to address the following questions: (1) What are the most common subjects studied? (2) What research designs and data-gathering strategies are commonly employed? (3) Where are these papers being published? (4) What subject and research design trends have emerged in the last decade? Design A literature review was conducted on surgical education publications from January 2008 to July 2018, using the search terms, “Graduate Medical Education,” and “General Surgery.” Inclusion criteria included articles published in the United States and Canada specific to general surgery and graduate medical education. Results A total of 1043 articles met inclusion criteria and were categorized according to year published, journal type, journal of publication, subject of research, research design, and data collection method. The following observations were noted: (1) curriculum/teaching remains the most common subject of surgical education research, with growing emphasis on program evaluation, well-being, duty hours, and case exposure. (2) Descriptive research is the most common, although qualitative and mixed methods research is becoming more common. (3) Online surveys are the most common data collection method as they are the quickest way to gather data but there is an increasing use of interviews as support for qualitative research grows. and (4) Surgical education papers are largely published in journals specifically designed for education, and have slowly grown in popularity in generalized surgical journals. Conclusions As surgical education continues to develop as a field, we anticipate further acceptance of qualitative research in major peer-reviewed surgical journals, increased emphasis on resident well-being, and more effective use of interviews and mixed methods including online resources for data collection.