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Francis SD, Kang AW, Maheta BJ, Sangalang BR, Salingaros S, Wu RT, Nazerali RS. National trends in revision procedures in post-mastectomy breast reconstruction: Autologous vs implant-based approaches. J Plast Reconstr Aesthet Surg 2024; 95:127-133. [PMID: 38905789 DOI: 10.1016/j.bjps.2024.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Breast reconstruction involves collaborative decision-making between patients and surgeons, but the need for multiple revisions after the initial reconstructive surgery process can burden patients and the healthcare system. This study explored how the type of breast reconstruction (autologous [ABR], immediate implant-based reconstruction [IBR], or two-stage IBR) impacts postreconstruction revision rates. METHOD Using MarketScan Databases, a retrospective database study (2007-2021) was conducted, identifying revision procedures through Current Procedural Terminology codes. Statistical analysis with linear models, adjusted for patient characteristics and surgical factors, used a significance threshold of p < 0.05. RESULTS Among 58,264 patients, 6.2% of ABR patients, 3.8% of immediate IBR patients, and 3.6% of two-stage IBR patients underwent future revisions. IBR had a 51% lower incidence rate of revision operations than ABR (incidence rate ratio = 0.49, p < 0.001). Within IBR, there was no significant difference in the number of operations between immediate IBR (0.06 ± 0.32) and two-stage IBR (0.05 ± 0.32, p = 0.95). Immediate IBR demonstrated 12% (OR = 0.88, p = 0.0022) and 70% (OR = 0.30, p < 0.001) lower odds of requiring breast revision and fat grafting compared to ABR, respectively. Two-stage reconstruction had 66 % lower odds of requiring only fat grafting than ABR (OR = 0.34, p < 0.001). CONCLUSION ABR necessitated a higher number of total revision procedures after completion of the initial reconstruction. These findings will better equip providers and patients to counsel patients in understanding their reconstructive journey, planning their reconstructions and timing, and provide more accurate estimates of the number of procedures that will be required to reach their aesthetic goals and final outcome.
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Affiliation(s)
| | | | - Bhagvat J Maheta
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Brian R Sangalang
- University of California Riverside School of Medicine, Riverside, CA, USA
| | | | - Robin T Wu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rahim S Nazerali
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Parmeshwar N, Barnes L, Martins D, Nicholas C, Piper M. The impact of post-mastectomy radiation timing on overall outcomes of autologous free-flap breast reconstruction. Microsurgery 2024; 44:e31091. [PMID: 37469230 DOI: 10.1002/micr.31091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The optimal timing of post-mastectomy radiation therapy (PMRT) in autologous breast reconstruction is controversial. Our study compares overall reconstructive outcomes in patients who received post-mastectomy radiation therapy either before or after the autologous flap. METHODS A single-center retrospective review was performed for patients who underwent free flap breast reconstruction and post-mastectomy radiation from January 2004 through January 2021. Demographic, intraoperative, and post-operative variables were recorded. RESULTS A total of 452 free flaps were identified, and 82 underwent PMRT. 59.8% were radiated with an expander prior to free flap surgery (PreFlap), and 40.2% flaps underwent PMRT (PostFlap). PostFlap patients were significantly younger (43.0 vs. 47.9 years, p = .016). There were no significant differences in free flap outcomes between the two cohorts including thrombosis, venous congestion, flap loss, takebacks, fat necrosis, seroma, or infection. Mastectomy skin flap necrosis was significantly higher in the PostFlap cohort (9.1% vs. 0%, p = .032), but nipple necrosis rates did not differ. There were no significant differences in number or need for revision surgeries, fat necrosis, or fat grafting between groups. However, there were significantly more total reconstructive complications, including infection and wound breakdown, experienced by the PreFlap cohort (46.9% vs. 24.2%, p = .038). CONCLUSIONS Timing of PMRT did not impact free flap outcomes, but those who had the expander radiated experienced significantly more complications overall. For the 34.7% of patients in the preFlap group who planned for autologous reconstruction form initial consultation, radiation after the flap may have improved their overall outcomes. As added complications cause delays in cancer therapy and final reconstruction, our results suggest that PMRT of the flap when possible may improve the overall experience for breast cancer patients.
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Affiliation(s)
- Nisha Parmeshwar
- Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California, USA
| | - Laura Barnes
- Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California, USA
| | - Deborah Martins
- Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California, USA
| | - Catherine Nicholas
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Merisa Piper
- Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California, USA
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Johnson BM, Dewitt J, Balanoff C, Kilgore L, Aripoli A, Collins M. Oncoplastic Breast Reconstruction for Large Pediatric Breast Tumors: A Case Series. Ann Plast Surg 2023; 91:36-41. [PMID: 37450859 DOI: 10.1097/sap.0000000000003576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
ABSTRACT Large breast fibroadenomas in pediatric females may cause discomfort, asymmetry, and psychological stress, and patients may elect for surgical excision. There are no criteria for reconstruction after the excision of these masses, and the research is limited in describing oncoplastic techniques in pediatric fibroadenoma excision. Nononcoplastic techniques, such as mastectomy with implant or flap reconstruction, have been used for pediatric fibroadenoma excision reconstruction. Oncoplastic techniques using Wise pattern or circumareolar incisions have shown to have efficacious outcomes. In addition, pediatric females undergoing breast surgery risk long-term complications such as continued breast asymmetry due to further breast growth, nipple and breast hypoesthesia, and future breastfeeding difficulty. This case series describes the oncoplastic techniques used for large benign mass excision and reconstruction of 3 pediatric females. A Wise pattern technique was used for all 3 patients, and 2 underwent a free-nipple graft. Oncoplastic techniques for pediatric breast mass excision provide satisfactory aesthetic outcomes with minimal surgical morbidity. Further research assessing the long-term effects of pediatric breast mass excision and reconstruction would be beneficial.
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Affiliation(s)
| | | | | | | | - Allison Aripoli
- Radiology, University of Kansas Medical Center, Kansas City, KS
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Abstract
Breast reconstruction is becoming increasingly recognized as a fundamental component in comprehensive breast cancer treatment. The primary goal for any reconstruction is to safely restore a natural appearing breast. When it comes to achieving the elements of size, shape, symmetry, and softness, the use of autologous tissue has many advantages. The approach to autologous breast reconstruction has changed substantially over the years as microsurgical free tissue transplants become more routine and accessible. While a variety of flap donor sites exist, careful flap selection based on surgical history and the availability of donor tissue is critical in achieving reliable results. This article reviews the clinical considerations in patient evaluation, donor site selection, and surgical approach taken at the Buncke Clinic.
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Affiliation(s)
- Rudolf Buntic
- Division of Microsurgery, The Buncke Clinic, San Francisco, California
| | - Alexander Y. Li
- Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, California
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Soon PS, Karimi N, Wu VS, Girgis A. Having breast reconstruction post-mastectomy: barriers and facilitators reported by Vietnamese- versus English-speaking women with breast cancer. ETHNICITY & HEALTH 2022; 27:343-360. [PMID: 31746239 DOI: 10.1080/13557858.2019.1693513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
Objective: Little is known about the experience of women of culturally and linguistically diverse (CALD) backgrounds in relation to breast reconstruction following mastectomy as treatment for their breast cancer. The aim of this study was to explore the factors that influenced Vietnamese- and English-speaking women's decisions about breast reconstruction post-mastectomy for their breast cancer, in Australia.Design: The participants in this study comprised of Vietnamese-speaking women of Vietnamese heritage, and English-speaking women from mixed ethnicities (Vietnamese included). In this qualitative study, Vietnamese-speaking and English-speaking women who had breast cancer treated by mastectomy with or without breast reconstruction participated in in-depth interviews. Interviews were undertaken in the woman's chosen language (Vietnamese or English), audio-recorded, transcribed/translated and analysed using thematic analysis.Results: Fourteen Vietnamese-speaking and 13 English-speaking patients were recruited. Participants identified age, lack of information, concerns regarding surgical procedure, fears about complications and cancer recurrence as barriers to breast reconstruction. Many more Vietnamese-speaking participants identified lack of information about breast reconstruction as a barrier compared to English-speaking participants. Both groups described the ability to wear clothing of their choice, partner influence, and the need to feel 'normal' as facilitators to having breast reconstruction. Vietnamese-speaking participants in particular identified doctor recommendation of breast reconstruction as a major facilitator.Conclusion: Lack of information about reconstruction was a persistent theme, though it was identified by more Vietnamese women as a barrier to having breast reconstruction. The results reinforce the importance of doctors' recommendations in helping particularly the Vietnamese women make an informed decision about reconstruction following mastectomy as treatment for their breast cancer.
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Affiliation(s)
- Patsy S Soon
- Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Neda Karimi
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Verena S Wu
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Afaf Girgis
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Li X, Meng M, Zhao J, Zhang X, Yang D, Fang J, Wang J, Han L, Hao Y. Shared Decision-Making in Breast Reconstruction for Breast Cancer Patients: A Scoping Review. Patient Prefer Adherence 2021; 15:2763-2781. [PMID: 34916786 PMCID: PMC8670888 DOI: 10.2147/ppa.s335080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022] Open
Abstract
For most breast cancer (BC) patients who have undergone a mastectomy, the decision whether to proceed with breast reconstruction (BR) is complicated and requires deliberation. Shared decision-making (SDM) helps to address those needs and promote informed value-based decisions. However, little is known about the SDM status for BR in BC patients. This scoping review describes: 1) basic characteristics of studies on BR SDM in BC patients; 2) factors influencing BR SDM in BC patients; 3) experience and perception of BR SDM in BC patients; and 4) outcome measures reported. This review was performed in accordance with the Arksey and O'Malley methodology. A total of 5 English and 4 Chinese databases were searched, as well as different sources from grey literature. The data extraction form was developed by referring to the objectives and the Ottawa Decision Support Framework (ODSF). Data was analyzed using thematic analysis, framework analysis and descriptive statistics, with findings presented in the tables and diagrams. A total of 1481 records were retrieved and 42 of these included after screening. In 21 (21/42, 50%) of the studies, patient decision aids (PDAs) were utilized, and in 17 (17/42, 40.48%) of the studies, the factors influencing the implementation of SDM were explored. Of these 17 studies, the factors influencing the implementation of SDM were categorized into the following: the patient level (17/17, 100%), the healthcare level (2/17, 11.76%) and the organizational and system level (7/17, 41.18%). A total of 8 (19.05%) of the 42 studies focused on patients' experiences and perceptions of SDM, and all studies used qualitative research methods. Of these 8 studies, a total of 7 (7/8, 87.50%) focused on patients' experiences of SDM participation, and 4 (4/8, 50.00%) focused on patients' perceptions of SDM. A total of 24 studies (24/42, 57.14%) involved quantitative outcome measures, where 49 items were divided into three classifications according to the outcomes of ODSF: the quality of the decision (17/24, 70.83%), the quality of the decision-making process (20/24, 83.33%), and impact (13/24, 54.17%). Although researchers have paid less attention to other research points in the field of SDM, compared to the design and application of SDM interventional tools, the research team still presents some equally noteworthy points through scoping review. For instance, the various factors influencing BC patients' participation in SDM for BR (especially at the healthcare provider level and at the organizational system level), patients' experiences and perceptions. Systematic reviews (SRs) should be conducted to quantify the impact of these different factors on BR SDM. Implementation of scientific theories and methods can inform the exploration and integration of these factors.
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Affiliation(s)
- Xuejing Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Meiqi Meng
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Xiaoyan Zhang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Dan Yang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Jiaxin Fang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Junxin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Liu Han
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People’s Republic of China
| | - Yufang Hao
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
- Correspondence: Yufang Hao Liangxiang High Education Park, Fangshan District, Beijing, 102488, People’s Republic of ChinaTel +86-13552850210 Email
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Lamore K, Flahault C, Untas A. Women and Partners' Information Need, Emotional Adjustment, and Breast Reconstruction Decision-Making Before Mastectomy. Plast Surg (Oakv) 2020; 28:179-188. [PMID: 32879875 PMCID: PMC7436843 DOI: 10.1177/2292550320928558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Our aim was to explore the differences between women and their partners on information need, emotional adjustment, and breast reconstruction (BR) decision-making after breast cancer diagnosis. A second aim was to explore these differences regarding surgery type (mastectomy vs immediate BR). METHODS Women newly diagnosed with a first nonmetastatic breast cancer and having a mastectomy were invited to fill out online questionnaires, in conjunction with their partners, before mastectomy. Questionnaires assessed their information need (Patient Information Need Questionnaire), emotional adjustment (Profile of Mood States), motivations to have BR or not, shared decision-making (Shared Decision-Making Questionnaire), and partner influence in BR decision-making. RESULTS Thirty (15 women and their partners) people took part in the study. Women and partners had similar levels of information need, emotional adjustment, and shared decision-making. However, partners did not entirely perceive why BR is wished or not by the women. Furthermore, partners of women having a mastectomy alone had higher scores of mood disturbance and a greater need for information, compared to partners of women having an immediate BR (P < .05). Likewise, men expressed a greater need for disease-oriented information than their loved ones (P < .05). CONCLUSIONS This is the first study to highlight differences in couples' experiences of breast cancer diagnosis and BR decision-making before mastectomy. Partners express an important need for information and do not entirely perceive why BR is wished or not by their loved ones. An online tool providing information to both women and partners could help them in breast cancer care pathway and BR decision-making.
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Affiliation(s)
- Kristopher Lamore
- Laboratory of Psychopathology and Health Processes (EA4057), Université de Paris, Boulogne-Billancourt, France
| | - Cécile Flahault
- Laboratory of Psychopathology and Health Processes (EA4057), Université de Paris, Boulogne-Billancourt, France
| | - Aurélie Untas
- Laboratory of Psychopathology and Health Processes (EA4057), Université de Paris, Boulogne-Billancourt, France
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8
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The effect of being informed on receiving immediate breast reconstruction in breast cancer patients. Eur J Surg Oncol 2018; 44:717-724. [DOI: 10.1016/j.ejso.2018.01.226] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/15/2018] [Accepted: 01/24/2018] [Indexed: 12/20/2022] Open
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9
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Beugels J, Bod L, van Kuijk SMJ, Qiu SS, Tuinder SMH, Heuts EM, Piatkowski A, van der Hulst RRWJ. Complications following immediate compared to delayed deep inferior epigastric artery perforator flap breast reconstructions. Breast Cancer Res Treat 2018; 169:349-357. [PMID: 29399731 PMCID: PMC5945748 DOI: 10.1007/s10549-018-4695-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/24/2018] [Indexed: 11/26/2022]
Abstract
Purpose As more breast cancer patients opt for immediate breast reconstruction, the incidence of complications should be evaluated. The aim of this study was to analyze the recipient-site complications and flap re-explorations of immediate compared to delayed deep inferior epigastric artery perforator (DIEP) flap breast reconstructions. Methods For this multicenter retrospective cohort study, the medical records of all patients who underwent DIEP flap breast reconstruction in three hospitals in the Netherlands between January 2010 and June 2017 were reviewed. Patient demographics, risk factors, timing of reconstruction, recipient-site complications, and flap re-explorations were recorded. Results A total of 910 DIEP flap breast reconstructions (n = 397 immediate and n = 513 delayed reconstructions) in 737 patients were included. There were no significant differences in major complications or flap re-explorations between immediate and delayed reconstructions. The total flap failure rate was 1.5 and 2.5% in the immediate and delayed group, respectively. Significantly more hematomas (OR 2.91; 95% CI 1.59–5.30; p = 0.001) and seromas (OR 3.60; 95% CI 1.14–11.4; p = 0.029) occurred in immediate reconstructions, whereas wound problems were more frequently observed in delayed reconstructions (OR 1.99; 95% CI 1.27–3.11; p = 0.003). Correction for potential confounders still showed significant differences for hematoma and seroma, but no longer for wound problems (p = 0.052). Conclusions This study demonstrated similar incidences of major recipient-site complications and flap re-explorations between immediate and delayed DIEP flap breast reconstructions. However, hematoma and seroma occurred significantly more often in immediate reconstructions, while wound problems were more frequently observed in delayed reconstructions. Electronic supplementary material The online version of this article (10.1007/s10549-018-4695-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Beugels
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - L Bod
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S S Qiu
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - S M H Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - E M Heuts
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, VieCuri Medical Center, Venlo, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
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Flitcroft K, Brennan M, Spillane A. Decisional regret and choice of breast reconstruction following mastectomy for breast cancer: A systematic review. Psychooncology 2017; 27:1110-1120. [DOI: 10.1002/pon.4585] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/08/2017] [Accepted: 10/28/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Kathy Flitcroft
- Breast and Surgical Oncology at The Poche Centre; North Sydney NSW Australia
- Northern Clinical School; University of Sydney; Sydney NSW Australia
| | - Meagan Brennan
- Breast and Surgical Oncology at The Poche Centre; North Sydney NSW Australia
- Northern Clinical School; University of Sydney; Sydney NSW Australia
| | - Andrew Spillane
- Breast and Surgical Oncology at The Poche Centre; North Sydney NSW Australia
- Northern Clinical School; University of Sydney; Sydney NSW Australia
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Ogrodnik A, MacLennan S, Weaver D, James T. Barriers to Completing Delayed Breast Reconstruction Following Mastectomy: a Critical Need for Patient and Clinician Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:700-706. [PMID: 27193412 DOI: 10.1007/s13187-016-1046-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Rates of breast reconstruction following mastectomy vary widely, and little is known about why women who originally express an interest in breast reconstruction do not receive it. Improved documentation of clinical decision-making is one of the potential benefits of the electronic health record (EHR), and may serve as a tool to enhance patient-centered, clinical outcomes research. The goals of this study were to explore patterns in delayed reconstruction (DR), identify barriers to follow through, and to determine the adequacy of EHR documentation in providing information about decision-making for breast reconstruction. Retrospective EHR review of women undergoing mastectomy, 2008-2012, was conducted in an academic medical center in New England. Data included patient demographics, cancer stage, co-morbidity index, post-mastectomy reconstruction status, and documented decision-making regarding reconstruction. Of 367 women who had undergone a total mastectomy, 219 did not receive immediate reconstruction. Of these, 24.6 % expressed no interest in DR, 21.9 % expressed interest but were still pending the procedure, and 5.9 % had completed DR. Of decision-making regarding breast reconstruction, 47.5 % lacked documentation. Median follow-up was 34 months. Reasons for not following through with DR included poor timing (25 %), indecision (17 %), desired method of reconstruction not available at treating facility (10 %), persistent obesity (8.3 %), continued smoking (4 %), and reason not specified (35 %). Many women do not receive breast reconstruction despite expressing an initial interest in the procedure. Reasons were multi-factorial and the extent of documentation was inconsistent. Further exploration of potential barriers to breast reconstruction as well as opportunities to enhance shared decision-making may serve to improve patient experience and satisfaction following mastectomy.
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Affiliation(s)
- Aleksandra Ogrodnik
- Department of Surgery, Danbury Hospital, Danbury, CT, USA
- Department of General Surgery Residency, 24 Hospital Ave, Danbury, CT, 06810, USA
| | - Susan MacLennan
- Department of Surgery, University of Vermont, 89 Beaumont Ave, Given Building, Burlington, VT, 05405, USA
- Department of Surgery, University of Vermont College of Medicine, 111 Colchester Ave, Burlington, VT, 05401, USA
| | - Donald Weaver
- Department of Pathology, University of Vermont, Burlington, VT, 05405, USA
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, 89 Beaumont Avenue, Courtyard at Given S269, Burlington, VT, 05405, USA
| | - Ted James
- Department of Surgery, University of Vermont, 89 Beaumont Ave, Given Building, Burlington, VT, 05405, USA.
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Distance to a Plastic Surgeon and Type of Insurance Plan Are Independently Predictive of Postmastectomy Breast Reconstruction. Plast Reconstr Surg 2017; 138:203e-211e. [PMID: 27465180 DOI: 10.1097/prs.0000000000002343] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The psychosocial benefits of postmastectomy breast reconstruction are well established; however, health care barriers persist. The authors evaluated statewide patient population to further identify obstacles to reconstruction. METHODS A linked data set combining the North Carolina Central Cancer Registry with administrative claims from Medicare, Medicaid, and private insurance plans identified women diagnosed with breast cancer from 2003 to 2006. For inclusion in the study, women must have had a mastectomy within 6 months of diagnosis and had continuous insurance enrollment at least 2 years postoperatively (n = 5381). Multivariable logistic regression was used to model odds of reconstruction. RESULTS Approximately 20 percent underwent reconstruction (n = 1130). Distance to a plastic surgeon-10 to 20 miles (OR, 0.78) and greater than 20 miles (OR, 0.73; p < 0.05)-was significantly predictive of no reconstruction, independent of other well-known disparities, including age, race, rural location, and lower household income. Women with government-funded health care, such as Medicare (OR, 0.58) and Medicaid (OR, 0.24; p < 0.001), were also significantly less likely to undergo reconstruction. Consistent with previous study, advanced cancer stage and receipt of radiation therapy decreased the likelihood of reconstruction. Furthermore, when the authors compared immediate to delayed reconstruction, rural location, chemotherapy, and radiation therapy were significantly predictive of delay. CONCLUSIONS This is the first population-based study to demonstrate distance to care and insurance plan as significant predictors of receipt of reconstruction. Additional research is needed to understand health care barriers and to determine whether distance to a plastic surgeon can be ameliorated by outreach programs. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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An Innovative Risk-Reducing Approach to Postmastectomy Radiation Delivery after Autologous Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1265. [PMID: 28507844 PMCID: PMC5426863 DOI: 10.1097/gox.0000000000001265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 01/20/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Postmastectomy radiation therapy (PMRT) has known deleterious side effects in immediate autologous breast reconstruction. However, plastic surgeons are rarely involved in PMRT planning. Our institution has adopted a custom bolus approach for all patients receiving PMRT. This offers uniform distribution of standard radiation doses, thereby minimizing radiation-induced changes while maintaining oncologic safety. We present our 8-year experience with the custom bolus approach for PMRT delivery in immediate autologous breast reconstruction. METHODS All immediate autologous breast reconstruction patients requiring PMRT after 2006 were treated with the custom bolus approach. Retrospective chart review was performed to compare the postirradiation complications, reconstruction outcomes, and oncologic outcomes of these patients with those of previous patients at our institution who underwent standard bolus, and to historical controls from peer-reviewed literature. RESULTS Over the past 10 years, of the 29 patients who received PMRT, 10 were treated with custom bolus. Custom bolus resulted in fewer radiation-induced skin changes and less skin tethering/fibrosis than standard bolus (0% vs 10% and 20% vs 35%, respectively), and less volume loss and contour deformities compared with historical controls (10% vs 22.8% and 10% vs 30.7%, respectively). CONCLUSIONS Custom bolus PMRT minimizes radiation delivery to the internal mammary vessels, anastomoses, and skin; uniformly doses the surgical incision; and provides the necessary radiation dose to prevent recurrence. Because custom bolus PMRT may reduce the deleterious effects of radiation on reconstructive outcomes while maintaining safe oncologic results, we encourage all plastic surgeons to collaborate with radiation oncologists to consider this technique.
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Making decisions about breast reconstruction: A systematic review of patient-reported factors influencing choice. Qual Life Res 2017; 26:2287-2319. [PMID: 28397191 DOI: 10.1007/s11136-017-1555-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Many studies have explored women's reasons for choosing or declining a particular type of breast reconstruction (BR) following mastectomy for breast cancer. This systematic review synthesises women's reasons for choosing a range of BR options, including no BR, in different settings and across time. METHODS Thirteen databases were systematically searched, with 30 studies (4269 participants), meeting the selection criteria. Information on study aim and time frame, participation rate, design/methods, limitations/bias, reasons and conclusions, as well as participant clinical and demographic information, was reported. An overall quality score was generated for each study. Reasons were grouped into eight domains. RESULTS While study methodology and results were heterogeneous, all reported reasons were covered by the eight domains: Feeling/looking normal; Feeling/looking good; Being practical; Influence of others; Relationship expectations; Fear; Timing; and Unnecessary. We found a strong consistency in reasons across studies, ranging from 52% of relevant publications citing relationship expectations as a reason for choosing BR, up to 91% citing fear as a reason for delaying or declining BR. Major thematic findings were a lack of adequate information about BR, lack of genuine choice for women and additional access limitations due to health system barriers. CONCLUSIONS Understanding women's reasons for wanting or not wanting BR can assist clinicians to help women make choices most aligned with their individual values and needs. Our thematic findings have equity implications and illustrate the need for surgeons to discuss all clinically appropriate BR options with mastectomy patients, even if some options are not available locally.
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Somogyi RB, Webb A, Baghdikian N, Stephenson J, Edward KL, Morrison W. Understanding the factors that influence breast reconstruction decision making in Australian women. Breast 2015; 24:124-30. [PMID: 25603922 DOI: 10.1016/j.breast.2014.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 09/11/2014] [Accepted: 11/22/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Breast reconstruction is safe and improves quality of life. Despite this, many women do not undergo breast reconstruction and the reasons for this are poorly understood. This study aims to identify the factors that influence a woman's decision whether or not to have breast reconstruction and to better understand their attitudes toward reconstruction. METHODOLOGY An online survey was distributed to breast cancer patients from Breast Cancer Network Australia. Results were tabulated, described qualitatively and analyzed for significance using a multiple logistic regression model. RESULTS 501 mastectomy patients completed surveys, of which 62% had undergone breast reconstruction. Factors that positively influenced likelihood of reconstruction included lower age, bilateral mastectomy, access to private hospitals, decreased home/work responsibilities, increased level of home support and early discussion of reconstructive options. Most common reasons for avoiding reconstruction included "I don't feel the need" and "I don't want more surgery". The most commonly sited sources of reconstruction information came from the breast surgeon followed by the plastic surgeon then the breast cancer nurse and the most influential of these was the plastic surgeon. CONCLUSIONS A model using factors easily obtained on clinical history can be used to understand likelihood of reconstruction. This knowledge may help identify barriers to reconstruction, ultimately improving the clinicians' ability to appropriately educate mastectomy patients and ensure effective decision making around breast reconstruction.
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Affiliation(s)
- Ron Barry Somogyi
- Division of Plastic & Reconstructive Surgery, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne, VIC 3002, Australia; Department of Plastic & Reconstructive Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - Angela Webb
- Division of Plastic & Reconstructive Surgery, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne, VIC 3002, Australia; Department of Plastic & Reconstructive Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Nairy Baghdikian
- Cogentum Inc., Level 9, 45 William St, P.O. Box 50, Darling South, VIC 3145, Australia
| | - John Stephenson
- Department of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, United Kingdom
| | - Karen-Leigh Edward
- Australian Catholic University and St Vincent's Private Hospital, Melbourne Nursing Research Unit, Faculty of Health Sciences, Australian Catholic University, Locked Bag 4115, MDC, Fitzroy, VIC 3065, Australia
| | - Wayne Morrison
- The O'Brien Institute of Microsurgery, 42 Fitzroy St, Fitzroy, VIC 3065, Australia; Department of Plastic & Reconstructive Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
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