Patient-reported long-term outcomes after mastectomy, comparing the quilt technique to the conventional method

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BACKGROUND: The quilt technique results in a significant reduction of postoperative complications after mastectomy. However, concerns remain about the long-term effects on cosmetics, pain, and shoulder function after the quilt technique. This study evaluated long-term patient-reported cosmetic outcomes after mastectomy, comparing the quilt and conventional techniques. METHODS: This retrospective multicentre evaluation study included 156 patients who underwent mastectomy between October 2018 and October 2022. Patients received quilting sutures (n = 81) or conventional closure (n = 75). The primary outcome was patient-reported cosmetic outcome, assessed using a 4-point Likert scale. Secondary outcomes were cosmetics evaluated by an expert panel, long-term shoulder function, and surgery-related pain. RESULTS: In the study cohort, the median age was 65 ± 18 years. Unilateral mastectomy was performed in 131 (84.0 %) patients and bilateral mastectomy in 25 (16.0 %) patients. The median time after surgery was 38 ± 23 months. Long-term cosmetic outcomes were not significantly different between the quilted and non-quilted cohorts (p = 0.114): in the quilted cohort, 7.5 % of patients rated their cosmetic outcome as poor, 27.5 % as fair, 41.3 % as good, and 23.8 % as excellent, compared to the non-quilted cohort, 20.6 % rated their outcome as poor, 23.5 % as fair, 39.7 % as good, and 16.2 % as excellent. Expert panel assessment, long-term shoulder function, and surgery-related pain were comparable between the cohorts. CONCLUSION: The quilt technique has no long-term deleterious effects regarding cosmetics, shoulder function, and surgery-related pain and can thus be applied safely in mastectomy wound closure. Concerns about long-term safety should be no argument for refraining from quilting.

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