Breast Reconstruction: Outcomes Analysis
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Transcript of Breast Reconstruction: Outcomes Analysis
Breast Reconstruction: Outcomes Analysis
Michael J Bass, MD, JDwww.drmichaeljbass.com
Michael J Bass Plastic Surgery, PLLC
Disclosures
• None• Still need some
Analysis Factors
• What affects outcome– Neoadjuvant chemotherapy (Malata)– Radiation (Cordeiro)
• Overall Satisfaction– Unilateral versus bilateral reconstruction (Craft)
Neoadjuvant Chemotherapy and Immediate Breast Reconstruction
• 171 patients (198 breasts) by one surgeon– 64 free flaps, 74 pedicled
flaps, 60 implant based• 53 neoadjuvant, 118
controls• Neoadjuvant phase III
randomized trial
Malata, et al, Plastic and Reconstructive Surgery July 2010;126(1):1-11
Neoadjuvant Chemo (cont.)
Malata, et al, Plastic and Reconstructive Surgery July 2010;126(1):1-11
Neoadjuvant Chemo (cont.)
• Minor complications:– 6 (10%) neoadjuvant, 9 (6%) controls (p=.380)
• Major complications: – 1 (2%) neoadjuvant; 3 (2%) controls (p=1.0)
• No effect of neoadjuvant chemotherapy on risk of complications nor delay in adjuvant radiation
• Paper did not evaluate patient or surgeon satisfaction of reconstruction
Malata, et al, Plastic and Reconstructive Surgery July 2010;126(1):1-11
Radiation and Implant Based Reconstruction
• 143 patients with 1 year of follow up receiving immediate tissue expander reconstruction (1995-2001); no autologous reconstruction patients
• 68 patients with chest wall radiation (CWR) four weeks after placement of permanent prosthesis
• 75 control patients during same period
Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81
Radiation and Implants (cont.)
• Patients received 50 Gray in 25-28 fractions
• 6 MV to reconstructed breast, axillary apex, and supraclavicular region
• 68% of irradiated patients had grade II-IV capsular contracture; 40% control group (p=.006)
Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81
Radiation and Implants (cont.)• Doctors: 80% of irradiated
patients marked good-excellent; 88% for non-irradiated patients
• Patient satisfaction based upon self assessment questionnaire
• 67% irradiated, 88% non-irradiated patients satisfied (p=.004)
Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81
Radiation and Implants (cont.)
• No discussion on tumor grade or disease stage• 72% of irradiated patients and 85% of non-
irradiated patients would have again elected for tissue expander based reconstruction
Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81
Unilateral Versus Bilateral Reconstruction and Satisfaction
• 702 women (910 reconstructions) identified between 1999-2006
• 494 unilateral reconstructions, 416 bilateral reconstructions
Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24
Unilateral Versus Bilateral (cont.)
Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24
Unilateral Versus Bilateral (cont.)
• Patient surveys mailed• Minimum post reconstruction time 13
months, average of 56 months for unilateral and 49 months for bilateral patients
• Survey response: 75% unilateral, 79% bilateral
Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24
Unilateral Versus Bilateral (cont.) Reconstruction (cont.)
Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24
Barriers To Reconstruction• Doctor recommendation to seek counseling with a plastic
surgeon– 7/10 women eligible for reconstruction after a mastectomy are
not informed that the option exists (ASPS poll, 2009)• Logistical problem of coordinating consultations and
immediate reconstruction• Immediate reconstruction: 23.4% for invasive breast
cancer, 36.4% for DCIS• Medicaid kerfuffle quadrification in Kentucky• Age >50, rural living, black least likely to get reconstruction
Thank You For Coming
• Your participation in this lecture creates new opportunities for newly diagnosed women
• Breast cancer is far away from being treated with a pill