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Delenne S, Philip CA, Guimont I, Bienstman J, Mojallal AA, Cortet M. Mastectomies for breast cancer: Comparison between peri-operative morbidity after simple mastectomy or after immediate breast reconstruction in a unicentric serie of 210 patients. J Gynecol Obstet Hum Reprod 2024; 53:102695. [PMID: 37995939 DOI: 10.1016/j.jogoh.2023.102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/07/2023] [Accepted: 11/19/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND In breast cancer surgery, IBR (immediate breast reconstruction) is widely proposed to patients without indications of adjuvant treatments and without risk factors of surgical complications. New INCa's guidelines (2022) allow the expansion of IBR indications. OBJECTIVE A retrospective, unicentric and safety study: post-operative complication rate after IBR in comparison with simple mastectomy (SM, reference treatment). MATERIEL AND METHOD This retrospective study has included all major patients who have received mastectomy for breast cancer between 2016 and 2020 before application of new guidelines, in Hôpital de la Croix-Rousse, Lyon (France). They were distributed in two groups according to their surgery : IBR and SM. Usual risk factors of post-operative complications were collected (tabacco, obesity…). The primary endpoint was the occurrence of an early post-operative complication (within 3 months after surgery). Two secondary analysis focused on the impact of preoperative risk factors on complications, and the proportion of patients eligibled for an IBR among SM based on new INCA's guidelines. RESULTS The study included 185 mastectomies: 153 SM, 32 mastectomies IBR. IBR's patients presented less risk factors, and few indications of adjuvant treatments. The rate of major complications was identical in the two groups (14 % in SM group, 12 % in IBR group), and there were more minor complications in the SM group than in the IBR group (p 0,01). According to our study, the raw proportion of initially possible IBR was 68 % (36 % of breast reconstruction in this study). CONCLUSION This analyse approve IBR in selected patients. In this context, INCa's guidelines (2022) can generalize IBR's proposal to patients. However, the analysis of pre-operative risk factors stay essential in medical care.
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Affiliation(s)
- Sybille Delenne
- Université Claude Bernard Lyon I, faculté de médecine, Lyon, France.
| | | | - Isabelle Guimont
- Service de gynécologie, Hôpital de la Croix-Rousse, Lyon, France
| | - Julie Bienstman
- Service de gynécologie, Hôpital de la Croix-Rousse, Lyon, France
| | - Alain-Ali Mojallal
- Service de chirurgie plastique et reconstructrice, Hôpital de la Croix-Rousse, Lyon, France
| | - Marion Cortet
- Service de gynécologie, Hôpital de la Croix-Rousse, Lyon, France
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Jimenez RB, Packowski K, Horick N, Rosado N, Chinta S, Koh DJ, Sobti N, Specht MC, Liao EC. The Timing of Acute and Late Complications Following Mastectomy and Implant-based Reconstruction. Ann Surg 2023; 278:e203-e208. [PMID: 35837894 DOI: 10.1097/sla.0000000000005574] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Implant-based breast reconstruction is a common plastic surgery procedure with well-documented clinical outcomes. Despite this, the natural history and timing of key complication endpoints are not well described. The goal of this study is to determine when patients are most likely to experience specific adverse events after implant-based reconstruction. METHODS Retrospective consecutive series of patients who received mastectomy and implant-based reconstruction over a 6-year period were included. Complications and unfavorable outcomes including hematoma, seroma, wound infection, skin flap necrosis, capsular contracture, implant rippling, and implant loss were identified. A time-to-event analysis was performed and Cox regression models identified patient and treatment characteristics associated with each outcome. RESULTS Of 1473 patients and 2434 total reconstructed breasts, 785 complications/unfavorable outcomes were identified. The 12-month cumulative incidence of hematoma was 1.4%, seroma: 4.3%, infection: 3.2%, skin flap necrosis: 3.9%, capsular contracture: 5.7%, implant rippling: 7.1%, and implant loss: 3.9%. In the analysis, 332/785 (42.3%) complications occurred within 60 days of surgery; 94% of hematomas, 85% of skin necrosis events, and 75% of seromas occurred during this period. Half of all infections and implant losses also occurred within 60 days. Of the remaining complications, 94% of capsular contractures and 93% of implant rippling occurred >60 days from surgery. CONCLUSIONS Complications following mastectomy and implant-based reconstruction exhibit a discrete temporal distribution. These data represent the first comprehensive study of the timing of adverse events following implant-based reconstruction. These findings are immediately useful to guide postoperative care, follow-up, and clinical trial design.
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Affiliation(s)
- Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Kathryn Packowski
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | - Nora Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Nikki Rosado
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | - Sachin Chinta
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | - Daniel J Koh
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | - Nikhil Sobti
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | - Michelle C Specht
- Department of Surgery, Division of Breast Surgery, Massachusetts General Hospital, Boston, MA
| | - Eric C Liao
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
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Marxen T, Shauly O, Losken A. The Safety of Same-day Discharge after Immediate Alloplastic Breast Reconstruction: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4448. [PMID: 35924002 PMCID: PMC9298472 DOI: 10.1097/gox.0000000000004448] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
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Hassan RAM, Urban CDA, Dória MT, Spautz CC, Rabinovich I, Anselmi KF, Schunemann E, Kuroda F, Sobreiro BP, Lima RSD. Exposed Implant after Immediate Breast Reconstruction - Presentation and Analysis of a Clinical Management Protocol. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:690-698. [PMID: 34670304 PMCID: PMC10183878 DOI: 10.1055/s-0041-1735939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. METHODS We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. RESULTS Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the original implant. CONCLUSION Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.
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Affiliation(s)
| | - Cícero de Andrade Urban
- Department of Post-graduation, Universidade Positivo, Curitiba, PR, Brazil.,Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | | | | | - Iris Rabinovich
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Paraná, PR, Brazil
| | | | - Eduardo Schunemann
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Paraná, PR, Brazil
| | - Flávia Kuroda
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
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5
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An Argument for the Safety of Immediate Device Reconstruction following Mastectomy during the COVID-19 Crisis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3627. [PMID: 34036031 PMCID: PMC8140773 DOI: 10.1097/gox.0000000000003627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
Although oncologic surgery is deemed urgent during the COVID-19 pandemic, clinical guidelines in reconstructive surgery have been unclear. Utilizing propensity-matched pre-pandemic data and our institutional experience during the crisis, we aimed to assess the safety of immediate device reconstruction following mastectomy to aid in decision-making during the pandemic.
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6
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Siegel EL, Whiting J, Kim Y, Sun W, Laronga C, Lee MC. Effect of surgical complications on outcomes in breast cancer patients treated with mastectomy and immediate reconstruction. Breast Cancer Res Treat 2021; 188:641-648. [PMID: 33939063 DOI: 10.1007/s10549-021-06241-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Operative complications affect recurrence in non-breast malignancies. Rising rates of mastectomy with immediate reconstruction and their increased post-operative complications fuel concerns for poorer outcome in breast cancer (BC). We sought to determine the effect of complications on recurrence in BC patients. METHODS A single-institution retrospective review was conducted of incident BC treated with mastectomy and immediate reconstruction. Overall survival and recurrence were compared between patients with complications to those without. RESULTS Of 201 patients (350 mastectomies, 86 nipple-sparing), 62 (30.8%) had a surgical complication. Patients with complications were older, but groups were similar for type of reconstruction, tobacco use, hormone receptor status, HER2, lymphovascular invasion, and pathologic stage (all p > 0.05). Twenty-two complications (10.9%) were infection, 5 (2.5%) dehiscence, 14 flap necrosis (7%), 21 hematomas (10.4%), and 8 nipple necroses (9%). Recurrence occurred in 18 (8.9%) patients: 4 local, 2 regional, and 12 distant. After 8.9 years of median follow-up, patients with complications trended towards higher recurrence (hazard ratio (HR) 2.23, log-rank p = 0.08, Cox regression p = 0.05), particularly with nipple necrosis (HR 3.28, log-rank p = 0.09, regression p = 0.06). Patients with other complications had similar recurrence-free survival to those without (all p > 0.05). Higher stage (HR 13.66, log-rank p = 0.03) and adjuvant radiation (HR 2.78, log-rank p = 0.04) cases were more likely to recur. Patients with complications had similar overall survival to those without (log-rank p > 0.05). CONCLUSION BC patients with surgical complications do not have lower overall survival. This finding may be due to the improved prognosis compared to non-breast malignancies.
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Affiliation(s)
- Emily L Siegel
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, 10920 McKinley Dr, Tampa, FL, 33612, USA
| | - Junmin Whiting
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, 10920 McKinley Dr, Tampa, FL, 33612, USA
| | - Younchul Kim
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, 10920 McKinley Dr, Tampa, FL, 33612, USA
| | - Weihong Sun
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, 10920 McKinley Dr, Tampa, FL, 33612, USA
| | - Christine Laronga
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, 10920 McKinley Dr, Tampa, FL, 33612, USA
| | - M Catherine Lee
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, 10920 McKinley Dr, Tampa, FL, 33612, USA.
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Youl P, Philpot S, Moore J, Theile DE. Population-based picture of breast reconstruction in Queensland, Australia. ANZ J Surg 2021; 91:695-700. [PMID: 33724641 DOI: 10.1111/ans.16675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Approximately 40% of women with invasive breast cancer will undergo a mastectomy. Clinical practice guidelines recommend breast reconstruction (BR) options should be discussed with all women who are to undergo a mastectomy. We sought to examine rates of BR, BR methods over time and to identify factors associated with the likelihood of receiving BR in Queensland. METHODS This population-based study used linked data from the Queensland Oncology Repository for 12 364 women who underwent a mastectomy for invasive breast cancer from 2008 to 2017. Multivariate logistic regression was used to model predictors of immediate breast reconstruction (IBR) and delayed breast reconstruction (DBR). RESULTS Overall, 2560 (20.7%) women had BR, with 9.8% having IBR and 10.9% having DBR. Factors associated with a reduced likelihood of IBR or DBR included older age (P < 0.001), living in a regional/rural area (P < 0.001) and having a mastectomy in a public versus private hospital (P < 0.001). Median time from mastectomy to DBR was 18.4 and 29.2 months for women attending a private versus public hospital, respectively (P < 0.001). Use of implant-based BR increased significantly with a corresponding decrease in autologous BR over time. CONCLUSIONS Significant disparities exist in rates of BR between public and private hospitals. Women living in regional and rural areas as well as those aged over 60 years continue to have lower rates of BR. Addressing the health system barriers and developing strategies to improve access to, and uptake of BR should be a priority.
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Affiliation(s)
- Philippa Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Shoni Philpot
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Julie Moore
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - David E Theile
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
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8
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Saheb-Al-Zamani M, Cordeiro E, O'Neill AC, Hofer SO, Cil TD, Zhong T. Early Postoperative Complications From National Surgical Quality Improvement Program: A Closer Examination of Timing and Technique of Breast Reconstruction. Ann Plast Surg 2021; 86:S159-S164. [PMID: 33208650 PMCID: PMC7969155 DOI: 10.1097/sap.0000000000002590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the recent surge in rates of immediate breast reconstruction, there is a paucity of large multicenter studies to compare differences in morbidity after immediate versus delayed breast reconstruction. This study used the National Surgical Quality Improvement Program (NSQIP) to study the association between timing of breast reconstruction and complication rates, stratified by reconstructive modality. STUDY DESIGN The NSQIP database was used to identify breast reconstructions from 2005 to 2012. Rates of major complications were compared by timing within each reconstructive modality (implant vs autologous). Cohort differences in baseline characteristics and variables associated with increased complication rates were identified in bivariate analyses. A multivariable model was created to compare the association between the timing of reconstruction and major complications. RESULTS Of 24,506 postmastectomy reconstructions, 85.8% were immediate, 14.2% were delayed, 84% were implant, and 16% were autologous reconstructions. Overall, 10.0% of patients suffered a major complication. After stratification, only implant reconstructions showed a statistically higher complication rate with immediate (8.8%) reconstruction compared with delayed (5.3%) (odds ratio, 1.7, P < 0.01). There was no significant difference in complication rates between autologous immediate (18.4%) or delayed (19.0%) reconstructions. After controlling for baseline cohort differences and other risk factors, immediate reconstruction remained as an independent significant predictor of major complications in implant reconstructions (odds ratio, 1.8, P < 0.01). CONCLUSIONS Immediate rather than delayed breast reconstruction is associated with a significantly higher rate of major complications in implant reconstruction but not in autologous reconstruction. It is important to include these findings in the routine preoperative surgeon-patient discussion of reconstructive options.
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Affiliation(s)
| | | | - Anne C. O'Neill
- From the Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto
| | - Stefan O.P. Hofer
- From the Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto
| | - Tulin D. Cil
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Toni Zhong
- From the Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto
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9
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Early postoperative outcomes in implant, pedicled, and free flap reconstruction for breast cancer: an analysis of 23,834 patients from the ACS-NSQIP datasets. Breast Cancer Res Treat 2021; 187:525-533. [PMID: 33462766 DOI: 10.1007/s10549-020-06073-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Many patients seek breast reconstruction following mastectomy. Debate exists regarding the best reconstructive option. The authors evaluate outcomes comparing implant, free flap, and pedicled flap reconstruction. METHODS Patients undergoing implant, pedicled flap, and free flap reconstruction were identified in the 2011-2016 NSQIP database. Demographics were analyzed and covariates were balanced using overlap propensity score. Logistic regression was used for binary outcomes and Gamma GLM for length of stay (LOS). RESULTS Of 23,834 patients, 87.7% underwent implant, 8.1% free flap, and 4.2% pedicled flap reconstruction. The implant group had the lowest mean operative time (206 min, SD 85.6). Implant patients had less pneumonia (OR 0.09, CI 0.02-0.36, p < 0.01), return to operating room (OR 0.62, CI 0.50-0.75, p < 0.01), venous thromboembolism (VTE) (OR 0.33, CI 0.14-0.79, p = 0.01), postoperative bleeding (OR 0.10, CI 0.06-0.15, p < 0.01), and urinary tract infections (UTI) (OR 0.21, CI 0.07-0.58, p < 0.01) than free flap patients. Pedicled flap patients had less postoperative bleeding (OR 0.69, CI 0.49-0.96, p = 0.03) than free flap patients. Pedicled flap patients had more superficial surgical site infections (p = 0.03), pneumonia (p = 0.02), postoperative bleeding (p < 0.01), VTE (p = 0.04), sepsis (p = 0.05), and unplanned reintubation (p = 0.01) than implant patients. Implant patients had the lowest LOS (1.6 days, p < 0.01). CONCLUSION Implant reconstruction has less short-term postoperative complications than free flaps and pedicled flap reconstructions. The overall complication rate among all reconstructive modalities remains acceptably low and patients should be informed of all surgical options.
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10
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High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis. Breast Cancer Res Treat 2020; 182:679-688. [PMID: 32562119 PMCID: PMC7304917 DOI: 10.1007/s10549-020-05739-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis. METHODS IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized. RESULTS Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed. CONCLUSION This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implant-based breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.
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11
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Immediate Breast Reconstruction in The Netherlands and the United States: A Proof-of-Concept to Internationally Compare Quality of Care Using Cancer Registry Data. Plast Reconstr Surg 2019; 144:565e-574e. [PMID: 31568284 DOI: 10.1097/prs.0000000000006011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Studies based on large-volume databases have made significant contributions to research on breast cancer surgery. To date, no comparison between large-volume databases has been made internationally. This is the first proof-of-concept study exploring the feasibility of combining two existing operational databases of The Netherlands and the United States, focusing on breast cancer care and immediate breast reconstruction specifically.313/291 METHODS:: The National Breast Cancer Organization The Netherlands Breast Cancer Audit (NBCA) (2011 to 2015) and the U.S. Surveillance, Epidemiology, and End Results (SEER) database (2010 to 2013) were compared on structure and content. Data variables were grouped into general, treatment-specific, cancer-specific, and follow-up variables and were matched. As proof-of-concept, mastectomy and immediate breast reconstruction rates in patients diagnosed with invasive breast cancer or ductal carcinoma in situ were analyzed. RESULTS The NBCA included 115 variables and SEER included 112. The NBCA included significantly more treatment-specific variables (n = 46 versus 6), whereas the SEER database included more cancer-specific variables (n = 74 versus 26). In patients diagnosed with breast cancer or ductal carcinoma in situ, immediate breast reconstruction was performed in 19.3 percent and 24.0 percent of the breast cancer cohort and 44.0 percent and 35.3 percent of the ductal carcinoma in situ cohort in the NBCA and SEER, respectively. Immediate breast reconstruction rates increased significantly over time in both data sets. CONCLUSIONS This study provides a first overview of available registry data on breast cancer care in The Netherlands and the United States, and revealed limited data on treatment in the United States. Comparison of treatment patterns of immediate breast reconstruction showed interesting differences. The authors advocate the urgency for an international database with alignment of (treatment) variables to improve quality of breast cancer care for patients across the globe.
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12
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Corcione S, Lupia T, De Rosa FG. Skin and soft tissue infections after breast surgery. Curr Opin Infect Dis 2019; 32:87-94. [PMID: 30695000 DOI: 10.1097/qco.0000000000000531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Breast surgery is considered a clean surgical procedure; nevertheless, infection rates are often higher than those reported after other similarly considered clean surgeries (e.g., thyroid, hernia). Acute bacterial skin and soft tissue infections, mostly surgical site infections and implant-associated infections are commonest events that could complicate postoperative care. RECENT FINDINGS Risk of infection is closely related to surgery procedure itself and patients host factors. Gram-positive bacteria with pattern of antimicrobial resistance are increasingly isolated and before today less frequent causes such as gram negative and mycobacteria infections. Impact of postoperative complications is underestimated and lacking an appropriate care and education for local and systemic management. SUMMARY We report the current evidence on the management of infections after breast surgery. New drugs options for methicillin-resistant Staphylococcus aureus and other gram positive should have a place in this setting. Stewardship activities aiming at reducing infections risks with the correct considerations of host, microbiological and surgical risk factors.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, University of Turin, City of Health and Sciences, Turin, Italy
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13
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Jabo B, Lin AC, Aljehani MA, Ji L, Morgan JW, Selleck MJ, Kim HY, Lum SS. Impact of Breast Reconstruction on Time to Definitive Surgical Treatment, Adjuvant Therapy, and Breast Cancer Outcomes. Ann Surg Oncol 2018; 25:3096-3105. [DOI: 10.1245/s10434-018-6663-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 12/11/2022]
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14
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Hansen N, Espino S, Blough JT, Vu MM, Fine NA, Kim JYS. Evaluating Mastectomy Skin Flap Necrosis in the Extended Breast Reconstruction Risk Assessment Score for 1-Year Prediction of Prosthetic Reconstruction Outcomes. J Am Coll Surg 2018; 227:96-104. [PMID: 29778821 DOI: 10.1016/j.jamcollsurg.2018.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Rates of mastectomy for breast cancer treatment and immediate reconstruction continue to rise. With increasing scrutiny on outcomes and patient satisfaction, there is an impetus for providers to be more deliberate in appropriate patient selection for breast reconstruction. The Breast Reconstruction Risk Assessment (BRA) Score was developed for prediction of complications after primary prosthetic breast reconstruction, focusing on calculating risk estimations for a variety of complications based on individual patient demographic and perioperative characteristics. In this study, we evaluated mastectomy skin flap necrosis (MSFN) as a function of patient characteristics to validate the BRA Score. STUDY DESIGN We examined our prospective intra-institutional database of prosthetic breast reconstructions from 2004 to 2015. The end point of interest was 1-year occurrence of MSFN after stage I tissue expander placement. RESULTS Nine hundred and three patients were included; 50% underwent bilateral reconstruction. Median follow-up was 23 months. Mean 1-year complication rates were as follows: MSFN 12.4%, seroma 3.0%, infection 6.9%, dehiscence/exposure 7.1%, and explantation 13.2%. Statistically significantly higher rates of MSFN were found in older patients, smokers, patients with postoperative infections, patients with hypertension, and patients who used aspirin. Neoadjuvant or adjuvant chemotherapy and radiation, diabetes, and seroma formation did not have a statistically significant impact on necrosis rates. CONCLUSIONS The BRA Score was expanded to estimate complication risk after tissue expander placement up to 1 year postoperatively. The risk of MSFN as calculated by the BRA Score: Extended Length is consistent with published studies demonstrating increased risk with specific comorbidities, and further validates expansion of the BRA score risk calculator.
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Affiliation(s)
- Nora Hansen
- Department of Surgery, Division of Breast Surgery, Northwestern Hospital, Chicago, IL
| | - Sasa Espino
- Department of Surgery, Division of Breast Surgery, Northwestern Hospital, Chicago, IL.
| | - Jordan T Blough
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael M Vu
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Neil A Fine
- Department of Surgery, Division of Plastic Surgery, Northwestern Hospital, Chicago, IL
| | - John Y S Kim
- Department of Surgery, Division of Plastic Surgery, Northwestern Hospital, Chicago, IL
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15
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Sousa J, Sood R, Liu D, Calhoun K, Louie O, Neligan P, Said H, Mathes D. Comparison of Outcomes in Immediate Implant-Based Breast Reconstruction Versus Mastectomy Alone. Plast Surg (Oakv) 2018; 26:18-25. [PMID: 29619355 DOI: 10.1177/2292550317731764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives Immediate implant-based techniques are common practice in post-mastectomy breast reconstruction. Previous studies have shown an increased complication rate in the setting of immediate versus delayed, MD reconstruction. We aimed to quantify any additional risk in complications when implant-based immediate breast reconstruction (IBR) is performed versus mastectomy alone. Materials and Methods We retrospectively reviewed all IBR cases and all mastectomies without reconstruction from 2007 to 2011. Patient characteristics, operative details, and complication rates were reviewed and analyzed. Results IBR was performed in 315 consecutive women; mastectomy alone was performed in 401 women. Patients undergoing mastectomy alone were more often older, diabetic, and more frequently underwent neoadjuvant chemotherapy or radiation. Overall complications were higher in the IBR group, most commonly reoperation and delayed wound healing. In a multivariate analysis, IBR, increasing age, body mass index, history of radiation therapy, smoking, and nipple-sparing mastectomy were independently associated with increased risk of complications. However, IBR was only independently associated with increased risk of major complications such as reoperation or readmission for intravenous antibiotics, not minor complications. Conclusion Patients selected for IBR are inherently different than those undergoing mastectomy alone. After adjusting for these differences, the increased risk of complications seen in IBR is moderately increased over the risk of complications in mastectomy alone. The observed increased risk of major complications after IBR is largely due to the aggressive management of complications in the setting of a prosthetic implant. IBR is a safe reconstructive strategy with only a slightly increased risk over mastectomy alone.
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Affiliation(s)
- Janelle Sousa
- Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Ravi Sood
- Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Daniel Liu
- Cancer Treatment Centers of America, Zion, IL, USA
| | - Kristine Calhoun
- Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Otway Louie
- Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Peter Neligan
- Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Hakim Said
- Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - David Mathes
- Division of Plastic and Reconstructive Surgery, University of Colorado, Aurora, CO, USA
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The National Surgical Quality Improvement Program 30-Day Challenge: Microsurgical Breast Reconstruction Outcomes Reporting Reliability. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1643. [PMID: 29707443 PMCID: PMC5908495 DOI: 10.1097/gox.0000000000001643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/29/2017] [Indexed: 12/04/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The aim was to assess reliability of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 30-day perioperative outcomes and complications for immediate, free-tissue transfer breast reconstruction by direct comparisons with our 30-day and overall institutional data, and assessing those that occur after 30 days. Methods: Data were retrieved for consecutive immediate, free-tissue transfer breast reconstruction patients from a single-institution database (2010–2015) and the ACS-NSQIP (2011–2014). Multiple logistic regressions were performed to compare adjusted outcomes between the 2 datasets. Results: For institutional versus ACS-NSQIP outcomes, there were no significant differences in surgical-site infection (SSI; 30-day, 3.6% versus 4.1%, P = 0.818; overall, 5.3% versus 4.1%, P = 0.198), wound disruption (WD; 30-day, 1.3% versus 1.5%, P = 0.526; overall, 2.3% versus 1.5%, P = 0.560), or unplanned readmission (URA; 30-day, 2.3% versus 3.3%, P = 0.714; overall, 4.6% versus 3.3%, P = 0.061). However, the ACS-NSQIP reported a significantly higher unplanned reoperation (URO) rate (30-day, 3.6% versus 9.5%, P < 0.001; overall, 5.3% versus 9.5%, P = 0.025). Institutional complications consisted of 5.3% SSI, 2.3% WD, 5.3% URO, and 4.6% URA, of which 25.0% SSI, 28.6% WD, 12.5% URO, and 7.1% URA occurred at 30–60 days, and 6.3% SSI, 14.3% WD, 18.8% URO, and 42.9% URA occurred after 60 days. Conclusion: For immediate, free-tissue breast reconstruction, the ACS-NSQIP may be reliable for monitoring and comparing SSI, WD, URO, and URA rates. However, clinicians may find it useful to understand limitations of the ACS-NSQIP for complications and risk factors, as it may underreport complications occurring beyond 30 days.
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Vora H, Chung A, Lewis A, Mirocha J, Amersi F, Giuliano A, Alban RF. Reconstruction among patients undergoing mastectomy: the effect of surgical deserts. J Surg Res 2018; 223:237-242. [DOI: 10.1016/j.jss.2017.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/24/2017] [Accepted: 11/03/2017] [Indexed: 01/22/2023]
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Effect of Drain Placement on Infection, Seroma, and Return to Operating Room in Expander-Based Breast Reconstruction. Ann Plast Surg 2017; 79:536-540. [DOI: 10.1097/sap.0000000000001174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Karunanayake M, Bortoluzzi P, Chollet A, Lin JC. Factors Influencing the Rate of Post-Mastectomy Breast Reconstruction in a Canadian Teaching Hospital. Plast Surg (Oakv) 2017; 25:242-248. [PMID: 29619346 DOI: 10.1177/2292550317728034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Post-mastectomy breast reconstruction (PMBR) improves psychosocial well-being, quality of life, and body image. Reconstruction rates vary widely (up to 42% in the United States), but the few Canadian studies available report rates of 3.8% to 7.9%. We sought to evaluate the current state of breast reconstruction in 1 Canadian teaching hospital and factors determining patients' access to reconstruction. Methods We performed a retrospective chart review of all patients with breast cancer undergoing mastectomy alone or mastectomy and reconstruction at a Canadian hospital between 2010 and 2013. We calculated rates of breast reconstruction and compared patient characteristics between the 2 groups, and then performed a multiple logistic regression to determine factors increasing the odds of receiving breast reconstruction. Results A total of 152 patients underwent 154 total or modified radical mastectomies. We obtained a rate of PMBR of 21%, 14% immediate reconstruction, and 8% delayed. Statistical analysis showed that compared to patients with mastectomy alone, patients who received PMBR were significantly younger, with a larger percentage having bilateral mastectomies, non-invasive breast cancer, and residing further from the hospital. Patients less than 50 years old and those with bilateral mastectomies had significantly greater odds of having a reconstruction. Conclusions Our Canadian tertiary care institution has a high volume of breast surgery and an active breast reconstruction team. However, the rate of immediate reconstruction remains low compared to similar centers in the United States. We recommend a united effort to increase awareness regarding PMBR and address common misconceptions hindering patients' access to breast reconstruction. Level of Evidence Epidemiologic study, Level III.
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Affiliation(s)
- Mihiran Karunanayake
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Québec, Canada
| | - Patricia Bortoluzzi
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Québec, Canada
| | - André Chollet
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Québec, Canada
| | - Jenny C Lin
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Québec, Canada
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Abstract
BACKGROUND Surgical-site infection causes devastating reconstructive failure in implant-based breast reconstructions. Large national database studies offer insights into complication rates, but only capture outcomes within 30 days postoperatively. This study evaluates both early and late surgical-site infection in immediate implant-based reconstruction and identifies predictors. METHODS As part of the Mastectomy Reconstruction Outcomes Consortium Study, 1662 implant-based breast reconstructions in 1024 patients were evaluated for early versus late surgical-site infection. Early surgical-site infection was defined as infection occurring within 30 days postoperatively; late surgical-site infection was defined as infection occurring 31 days to 1 year postoperatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant patients had 1-year follow-up, and tissue expander patients had 1-year post-exchange follow-up. RESULTS Among 1491 tissue expander and 171 direct-to-implant reconstructions, overall surgical-site infection rate for tissue expander was 5.7 percent (85 of 1491) after first-stage, 2.5 percent (31 of 1266) after second-stage, and 9.9 percent (17 of 171) for direct-to-implant reconstruction. Over 47 to 71 percent of surgical-site infection complications were late surgical-site infection. Multivariate analysis identified radiotherapy and increasing body mass index as significant predictors of late surgical-site infection. No significant difference between the direct-to-implant and tissue expander groups in the occurrence of early, late, or overall surgical-site infection was found. CONCLUSIONS The majority of surgical-site infection complications in immediate implant-based breast reconstructions occur more than 30 days after both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset surgical-site infection. Current studies limited to early complications do not present a complete assessment of infection associated with implant-based breast reconstructions or their long-term clinical outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Surveillance and Prevention of Surgical Site Infections in Breast Oncologic Surgery with Immediate Reconstruction. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017; 9:155-172. [PMID: 28959143 DOI: 10.1007/s40506-017-0117-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Surgical site infection (SSI) after immediate breast reconstruction is much more common than would be expected after a clean surgical procedure. Although the SSI rates reported in individual studies are quite variable, there are no obvious explanations for the variation in infection rates between institutions. The microbiology of these SSIs is unusual, with higher proportions of infections caused by atypical Myobacterium species and Gram-negative bacilli than would be expected for this anatomic site. In an effort to prevent SSIs, many surgeons use a variety of different practices including irrigation and soaking of implants with antibiotic solutions and prolonged duration of prophylactic antibiotics, although the literature to support these practices is very sparse. In particular, prolonged use of antibiotics post-discharge is concerning due to the potential for harm, including increased risk of Clostridium difficile infection, development of antibiotic resistant organisms, and drug-related allergic reactions. With higher rates of mastectomy and breast implant reconstruction in women with early-stage breast cancer, including greater utilization of reconstruction in higher-risk individuals, the number of women suffering from infection after oncologic reconstruction will likely continue to increase. It is imperative that more research be done to identify modifiable factors associated with increased risk of infection. It is also essential that larger studies with rigorous study designs be performed to identify optimal strategies to decrease the risk of SSI in this vulnerable population.
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Mastectomy and Immediate Breast Reconstruction for Cancer in the Elderly: A National Cancer Data Base Study. J Am Coll Surg 2017; 224:895-905. [DOI: 10.1016/j.jamcollsurg.2016.12.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 12/27/2022]
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Santosa KB, Qi J, Kim HM, Hamill JB, Pusic AL, Wilkins EG. Effect of Patient Age on Outcomes in Breast Reconstruction: Results from a Multicenter Prospective Study. J Am Coll Surg 2016; 223:745-754. [PMID: 27806906 DOI: 10.1016/j.jamcollsurg.2016.09.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although >40% of new breast cancer diagnoses in the US are in older women, few studies have assessed the outcomes of post-mastectomy reconstruction in this population. Our objective was to evaluate age effects on postoperative complications and patient-reported outcomes in women undergoing breast reconstruction, and to investigate whether age effects differ between reconstructive procedure types. STUDY DESIGN Eligible patients in the Mastectomy Reconstruction Outcomes Consortium study from 11 institutions (57 providers) in North America were analyzed. Two-year complications and patient-reported outcomes via BREAST-Q domains were compared across younger (younger than 45 years), middle-aged (45 to 60 years), and older (older than 60 years) women. Mixed-effects regression models were used, controlling for a range of demographic and clinical covariates. RESULTS A total of 1,531 patients were studied: 494 younger, 803 middle-aged, and 234 older. Age was not a significant predictor of complications. For sexual well-being 2 years post-reconstruction, older women reported 4.25 (p = 0.04) higher mean scores with implant procedures, and 10.39 (p < 0.01) higher mean scores with autologous procedures compared with younger women. No age effect was seen with implant procedures with regard to physical and psychosocial well-being; however, older women who underwent autologous procedures reported 6.07 (p < 0.01) higher physical, and 8.21 (p < 0.01) higher psychosocial well-being scores than younger women. CONCLUSIONS Age did not significantly affect complication rates. Older women demonstrated higher sexual well-being for both procedures, and better satisfaction and physical and psychosocial well-being than younger women with autologous procedures. Post-mastectomy reconstruction is a viable option for older patients, with risks and benefits comparable with those in younger women.
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Affiliation(s)
- Katherine B Santosa
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Ji Qi
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Hyungjin M Kim
- Center for Statistical Consultation and Research, Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Jennifer B Hamill
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Andrea L Pusic
- Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Edwin G Wilkins
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
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Breast reconstruction and risk of lymphedema after mastectomy: A prospective cohort study with 10 years of follow-up. J Plast Reconstr Aesthet Surg 2016; 69:1218-26. [DOI: 10.1016/j.bjps.2016.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 05/25/2016] [Accepted: 06/04/2016] [Indexed: 11/23/2022]
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McDonald ES, Clark AS, Tchou J, Zhang P, Freedman GM. Clinical Diagnosis and Management of Breast Cancer. J Nucl Med 2016; 57 Suppl 1:9S-16S. [DOI: 10.2967/jnumed.115.157834] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Patterns and Trends in Immediate Postmastectomy Reconstruction in California: Complications and Unscheduled Readmissions. Plast Reconstr Surg 2015; 136:10e-19e. [PMID: 26111325 DOI: 10.1097/prs.0000000000001326] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immediate reconstruction rates after mastectomy are increasing but remain low. Little is known about hospital readmissions after these procedures. The authors studied unscheduled readmissions after immediate reconstruction. METHODS Using the Healthcare Cost and Utilization Project California State database, the authors identified patients undergoing mastectomy only or with immediate reconstruction for ductal carcinoma in situ and invasive breast cancer from 2005 to 2009. Immediate reconstruction included tissue expander/implant and autologous tissue reconstructions. The authors evaluated temporal trends in immediate reconstruction and factors associated with 30-day unscheduled readmissions after reconstruction. RESULTS The cohort contained 48,414 patients (mastectomy only, 35,648; immediate reconstruction, 12,766; tissue expander/implant, 10,437; autologous tissue, 2329). Readmission rates were not significantly different between mastectomy only and immediate reconstruction (3.55 percent versus 3.39 percent; p = 0.39); however, autologous tissue reconstruction was associated with a significantly higher readmission rate compared with tissue expander/implant reconstruction (4.08 percent versus 3.24 percent; p = 0.04). CONCLUSIONS Immediate reconstruction does not result in higher readmission rates compared with mastectomy only. All women undergoing mastectomy should be offered consultation for reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Lack of Validity of the American College of Surgeons National Surgical Quality Improvement Program Database for Alloplastic Immediate Postmastectomy Reconstruction. Plast Reconstr Surg 2015; 136:296e-300e. [DOI: 10.1097/prs.0000000000001515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kwok AC, Goodwin IA, Ying J, Agarwal JP. National trends and complication rates after bilateral mastectomy and immediate breast reconstruction from 2005 to 2012. Am J Surg 2015; 210:512-6. [PMID: 26054659 DOI: 10.1016/j.amjsurg.2015.03.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study's purpose was to examine the national rate of breast cancer patients undergoing bilateral mastectomy (BM) and immediate breast reconstruction (IBR) and their associated complication rates. METHODS Using the National Surgical Quality Improvement Program database, breast cancer patients undergoing mastectomy between 2005 and 2012 were identified. Rates in BM and IBR as well as associated complication rates were evaluated. Logistic regression was used to identify predictors of BM, IBR, and complications. RESULTS A total of 56,905 breast cancer patients underwent mastectomy. The rate of BM tripled (9.14% vs 25.44%, P < .0001) and the rate of IBR increased by 50% (29.73% vs 44.68%, P < .0001). Complication rates were higher in patients undergoing BM compared with unilateral mastectomy (11.49% vs 9.52%, P < .0001) and in patients undergoing IBR compared with mastectomy alone (11.62% vs 8.91%, P < .0001). White race and age less than 40 years were predictors of patients undergoing BM and IBR. CONCLUSIONS The rates of BM and associated IBR have increased significantly since 2005 despite higher complication rates. Further research is needed to understand the reasons for these trends.
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Affiliation(s)
- Alvin C Kwok
- Division of Plastic Surgery, Department of Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| | - Isak A Goodwin
- Division of Plastic Surgery, Department of Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| | - Jian Ying
- Division of Epidemiology, Department of Family and Preventative Medicine, University of Utah, School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Jayant P Agarwal
- Division of Plastic Surgery, Department of Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT 84132, USA.
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30
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Schneider LF, Mehrara BJ. De-mythifying breast reconstruction: a review of common misconceptions about breast reconstruction. J Am Coll Surg 2015; 220:353-61. [PMID: 25600975 DOI: 10.1016/j.jamcollsurg.2014.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Lisa F Schneider
- The Institute for Advanced Reconstruction at the Plastic Surgery Center, Shrewsbury, NJ.
| | - Babak J Mehrara
- Division of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Memorial Sloan Kettering Hospital, New York, NY
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