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Soon PS, Kamalmaz K, Wu VS, Karimi N, Gerges M, Sherman KA, Girgis A. To Reconstruct or Not to Reconstruct: Piloting a Vietnamese and Arabic Breast Reconstruction Decision Aid in Australia. Curr Oncol 2024; 31:3713-3737. [PMID: 39057146 PMCID: PMC11275298 DOI: 10.3390/curroncol31070274] [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: 05/03/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Currently, there are no resources to support culturally and linguistically diverse (CALD) women with breast cancer to make decisions about undergoing breast reconstruction (BR). This study evaluated the usability and acceptability of decision aids (DAs) for Vietnamese- and Arabic-speaking women. This two-phase qualitative recruited Vietnamese- (Phase 1) and Arabic-speaking (Phase 2) adult (age ≥ 18 years) women who were diagnosed with breast cancer and could read Vietnamese/Arabic. Women participated in either think-aloud telephone interviews (Phase 1) or semi-structured telephone interviews (Phase 2) and provided feedback on the DA. Interviews were audio-recorded, translated, and transcribed from Vietnamese/Arabic to English, and inductive thematic analysis was undertaken. Additionally, Arabic-speaking women completed the Preparation for Decision Making (PrepDM) scale in Round 2. Twenty-five women were recruited in two phases (Phase 1: Vietnamese-speaking women, n = 14; Phase 2: Arabic-speaking, n = 11). Three themes were developed in Phase 1: (1) DA content and reception; (2) linguistic attributes and cultural appropriateness; and (3) factors that improve the DAs' impact. Three themes were developed in Phase 2: (1) varying perceptions of DA content; (2) linguistic and cultural suitability of information; and (3) impact of DA on decision making. Women from both phases identified areas for improvement: minimising the use of medical terminology, considering the cultural taboos associated with the word 'breast', and addressing remaining information gaps. Both language DAs were generally perceived as acceptable and useful in providing information about BR options and prompting women's reflections about the suitability of BR as part of their treatment. The mean PrepDM score for Arabic-speaking women in Round 2 was 4.8/5 (SD = 0.3). Further work is needed to ensure that culturally adapted DAs take into account the myriad of information needs and health literacy levels. The key role of healthcare professionals in shared decision making among CALD populations should also be considered.
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Affiliation(s)
- Patsy S. Soon
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
- Department of Surgery, Bankstown Hospital, Bankstown, NSW 2200, Australia
| | - Khouloud Kamalmaz
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Verena S. Wu
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
| | - Neda Karimi
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
- Institute for Communication in Healthcare, Australian National University, Acton, ACT 2601, Australia
| | - Martha Gerges
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
| | - Kerry A. Sherman
- School of Psychological Sciences, Lifespan Health and Wellbeing Research Centre, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
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Li X, Meng M, Yang D, Zhang J, Zhang X, Zhao J, Yin Y, Pei X, Hao Y. "All about the value?" Decisional needs of breast reconstruction for breast cancer patients in the Chinese context: A mixed-methods study. PATIENT EDUCATION AND COUNSELING 2024; 120:108102. [PMID: 38141445 DOI: 10.1016/j.pec.2023.108102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/15/2023] [Accepted: 12/09/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To explore breast cancer (BC) patients' participation in breast reconstruction (BR) decision-making and specific decisional needs, especially the manifestations and causes of decisional conflicts, in China. METHODS A mixed-methods study was conducted using triangulation of data from interviews and a questionnaire survey with health care professionals (HCPs) and BC patients with BR decision-making experience at 5 Beijing centers. The Ottawa Decision Support Framework guided (ODSF) the qualitative and quantitative data analyses. RESULTS A total of 82.53% of Chinese BC patients would consider BR. Seven themes captured patients' BR decisional needs per the ODSF: inadequate support/resources (100%, 58.82%) and knowledge (75%, 52.94%) were most frequently cited. Health beliefs (unclear values) reflected Chinese characteristics. Patients had inadequate knowledge (M=19.99/50, SD=8.67) but positive BR attitudes (M=59.48/95, SD=10.45). CONCLUSIONS BR decisions for Chinese BC patients are complex and often accompanied by decisional conflicts. Inadequate knowledge and inadequate support and resources contribute to these conflicts, emphasizing the need for culturally tailored information and support to promote SDM. PRACTICE IMPLICATIONS HCPs need specialized training in SDM to guide patients in decision-making. It is essential to provide relevant resources and support that are culturally and clinically appropriate for Chinese patients.
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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
| | - 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
| | - Jingyuan 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
| | - 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
| | - Junqiang Zhao
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON L9M 1G3, Canada
| | - Yiyi Yin
- 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
| | - Xue Pei
- School of Management, Beijing University of Chinese Medicine, 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.
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Tian Y, Birks S, Kemp S, Lee JC, Weymouth M, Serpell J, Walker M. Patterns of breast reconstruction and the influence of a surgical multidisciplinary clinic. ANZ J Surg 2024; 94:163-168. [PMID: 38071497 DOI: 10.1111/ans.18816] [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: 05/29/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Of the 40% of breast cancer patients who have a mastectomy as part of their surgical treatment, only approximately 29% have a breast reconstruction. In 2016, Alfred Health established a multidisciplinary surgical clinic with breast and plastic surgeons, aiming to improve interdisciplinary collaboration. This study aimed to assess the provision of breast reconstruction at an Australian tertiary public hospital and examine whether the multidisciplinary surgical clinic have improved our reconstructive service provision. METHODS A retrospective cohort study of patients who underwent mastectomy at Alfred Health between October 2011 and September 2021 was conducted. Patients were divided into before and after groups, treated during the 5-year period before and after establishing the multidisciplinary clinic respectively. Demographic data, operative details, histopathology, and treatments were compared. RESULTS Over the 10-year period, 423 mastectomies were performed for 351 patients. Of those, 153 patients underwent breast reconstruction, providing an overall reconstruction rate of 43.6%. There was a statistically significant increase in the breast reconstruction rate from 36.5% before to 53.4% after the creation of the multidisciplinary surgical clinic. Patient factors such as age and tumour receptor status did not differ significantly between the groups. CONCLUSION The establishment of a surgical multidisciplinary clinic has led to a statistically significant increase in the rate of breast reconstruction from 36.5% to 53.4%, leading to improved healthcare provision for our patients. Factors identified to be associated with increased uptake in the reconstruction service include younger age and node negative disease.
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Affiliation(s)
- Yuan Tian
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Sarah Birks
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Sarah Kemp
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
| | - James C Lee
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of General Surgery, Monash Health, Clayton, Victoria, Australia
| | - Michael Weymouth
- Plastic Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Plastic and Reconstructive Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of General Surgery, Peninsula Health, Frankston, Victoria, Australia
| | - Melanie Walker
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Department of General Surgery, Monash Health, Clayton, Victoria, Australia
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Mishra A, Nair J, Sharan AM. Coping in Post-Mastectomy Breast Cancer Survivors and Need for Intervention: Systematic Review. Breast Cancer (Auckl) 2023; 17:11782234231209126. [PMID: 37954028 PMCID: PMC10638885 DOI: 10.1177/11782234231209126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
Background Breast cancer is the most prominent cancer type to affect women. Surgical treatment of invasive breast cancers involves mastectomy. Due to mastectomy, women are subjected to social, emotional, and cultural problems which need to be addressed. Objective The objective of the study is to understand how women cope with body image-related issues, trauma, anxiety, and depression post-mastectomy. Design A systematic literature review was conducted for understanding the coping in post-mastectomy patients. The methods for identifying the studies were based on Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines. Databases Medline/PubMed, PsycInfo, and Cochrane databases were used for searching relevant articles. A final of 19 studies were analyzed for the work. Methods Search strings such as "coping strategies and post mastectomy," "body image coping and post mastectomy" and "anxiety coping and post mastectomy" were used for identification of references from databases. Eligibility criteria were used for finalizing the references. Results Analysis of the 19 studies has clearly shown that women who undergo mastectomy suffer from anxiety, stress, and trauma. This study has observed that women have problems with their body image post-mastectomy along with bouts of depression. Self-coping has been observed in relatively few studies. Psychological interventions before surgery have been observed to be a better coping strategy. In most of the studies, women opted for breast reconstruction to overcome the trauma associated with mastectomy. Conclusion Mastectomy has a severe impact on women's appearance and psychology. Breast reconstruction and acceptance have played an important role in coping among these women. However, breast reconstruction is not accepted by many women due to a multitude of factors. Thus, it is essential to have proper intervention programs in place to ensure women can cope with this situation and can lead healthy lives. Registration Systematic literature review (SLR) is submitted to PROSPERO. The application confirmation number is 449135.Registration awaited from the database.
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Alsubhi FS, Alothman MA, Alhadlaq AI. The International Awareness of Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5417. [PMID: 38025611 PMCID: PMC10659690 DOI: 10.1097/gox.0000000000005417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023]
Abstract
Background To our knowledge, this is the first and largest study conducted to collect data among surgeons worldwide about breast reconstruction. We have aimed to collect data about breast reconstruction worldwide, the most popular breast reconstruction techniques, and the barriers behind the low rate of breast reconstruction according to surgeons. Methodology A comparative cross-sectional design was used in this study. A prepared questionnaire, which was developed after reviewing the literature review conducted for this study, was used to collect data. The questionnaire is multiple choice. It was distributed among surgeons online. Results The study includes 812 participants who live all over the world, representing 79 countries. More than a third of surgeons perform less than 10 breast reconstructions per year (33.38%), and 45.86% of them think that immediate surgery is the most frequent practice. A higher percentage of participants prefer implants over autologous reconstruction as a technique for breast reconstruction (54.9%). Moreover, 39.02% of participants shared that a lack of knowledge about the availability of breast reconstruction was a reason for refusing the surgery. Conclusions This study demonstrates that the breast reconstruction rate is still low and that most surgeons prefer implants that are performed immediately. The lack of knowledge among patients about the availability of breast reconstruction is the most common reason for refusing reconstruction. Therefore, there is a need to increase patient awareness about the availability of this surgery.
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Affiliation(s)
- Fatema S. Alsubhi
- From the Plastic Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed A. Alothman
- From the Plastic Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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van Bekkum S, Clarijs ME, van der Veen FJC, van Rosmalen J, Koppert LB, Menke-Pluijmers MBE. What affects women's decision-making on breast reconstruction after mastectomy for breast cancer? Breast Cancer 2023; 30:772-784. [PMID: 37303033 DOI: 10.1007/s12282-023-01471-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/20/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE To establish the breast reconstruction rate in a large Dutch teaching hospital, and to gain insight into the motives of women to opt for or reject post-mastectomy breast reconstruction. METHODS In a retrospective, cross-sectional study, all consecutive patients who underwent mastectomy for invasive breast cancer or ductal carcinoma in situ (DCIS) were identified and categorized into two groups based on subsequent breast reconstruction or not. Patient-reported outcomes were assessed with the validated Breast-Q and a short survey about the decision-making process in breast reconstruction. These outcomes were compared between the two groups using univariable analyses, multivariable logistic regression, and multiple linear regression analyses. The Breast-Q scores were also compared to Dutch normative values. RESULTS A total of 319 patients were identified of whom 68% had no breast reconstruction. Of the 102 patients with breast reconstruction, the majority (93%) received immediate, instead of delayed breast reconstruction. The survey was completed by 155 (49%) patients. The non-reconstruction group, on average, reported significantly poorer psychosocial well-being, compared to the reconstruction group as well as compared to the normative data. However, the majority of the non-reconstruction group (83%) stated that they had no desire for breast reconstruction. In both groups, most patients stated that the provided information was sufficient. CONCLUSION Patients have personal motives to opt for or reject breast reconstruction. It seemed that patients differ in their rating of values that affect their decision since the same arguments were used to opt for or reject reconstruction. Notably, patients were well-informed in their decision making.
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Affiliation(s)
- Sara van Bekkum
- Department of Surgery, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK, Dordrecht, The Netherlands
| | - Marloes E Clarijs
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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Tyner TE, Freysteinson WM, Evans SC, Woo J. "My body, my choice": A qualitative study of women's mastectomy with flat closure experiences. Body Image 2023; 46:419-433. [PMID: 37573764 DOI: 10.1016/j.bodyim.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
This qualitative study aimed to describe and explore the pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis. Aesthetic flat closure creates a flat contoured chest wall after a mastectomy. There is limited research on women's flat closure experiences. To fill this gap, we interviewed 19 women (Mage = 53, range 31-72) with breast cancer who underwent a bilateral mastectomy with flat closure, examining decision-making, mirror-viewing, and flat closure experiences. Using a hermeneutic phenomenological design, we generated seven themes. Broadly, women choosing flat closure experienced pressure from their clinicians to undergo breast reconstruction. We found flat closure information to be consistently lacking. Mirror-viewing experiences of women obtaining suboptimal flat closure outcomes led to shattered expectations, mirror avoidance, psychological distress, and body image disturbances. Women negotiated their new reality by discovering ways to feel comfortable with their flat bodies. Regardless of surgical outcome, decision satisfaction was high. These findings illustrate the importance of bodily autonomy and supportive healthcare environments for women making flat closure decisions. Providing comprehensive information on all surgical options and addressing post-operative expectations can improve women's decision-making and mirror-viewing experiences and assist women in adapting to their new body image.
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Affiliation(s)
- Tracy E Tyner
- College of Nursing, Texas Woman's University, P.O. Box 425498, ASB 216, Denton, TX 76204-5498, USA.
| | - Wyona M Freysteinson
- Nelda C. Stark College of Nursing, Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA
| | - Stephanie C Evans
- Houston J. and Florence A. Doswell College of Nursing, Texas Woman's University, 5500 Southwestern Medical Avenue, Dallas, TX 75235-7299, USA
| | - Jennifer Woo
- Houston J. and Florence A. Doswell College of Nursing, Texas Woman's University, 5500 Southwestern Medical Avenue, Dallas, TX 75235-7299, USA
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Gunness P, Hamilton S, Capstick R, Masters J, Toma R. The development of a rural breast reconstruction service: patient reported outcomes and benefits. ANZ J Surg 2023; 93:1935-1937. [PMID: 36944602 DOI: 10.1111/ans.18389] [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: 01/11/2023] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND In 2021, breast cancer was one of the most commonly diagnosed cancer in Australia. While a mastectomy remains a treatment of choice, only a small percentage of women have access to a breast reconstruction after. Women living in a rural area are less likely to have a breast reconstruction; compared to their metropolitan counterparts. This study analyses the impact of single breast reconstruction service on a Modified Monash 3 (MM3) region and informs consumers and providers of the importance of a breast reconstruction unit embedded in a rural health network. [Corrections added on 2 May 2023, after online publication. Expanded reference citations have been deleted from Abstract section.] METHODS: Following ethics approval, all 64 patients who had undergone a breast reconstruction with this service between 2017 and 2021 were contacted. Patient reported outcomes were recorded through phone interviews, using a standardized questionnaire. For each patient that presented to the rural centre, cost of travel and productivity loss were also calculated, and compared to the closest metropolitan centre. RESULT Ninety-seven percent of the 38 participants strongly valued having a breast reconstruction service within their community. Eighty percent of participants were satisfied with their result. Patients were estimated to save on average $8478, by attending the rural breast reconstruction service. CONCLUSION Access to a breast reconstruction is significantly impacted by geographical barriers. A rural breast reconstruction service can improve patient access and satisfaction, while also reducing the financial burden on patients.
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Affiliation(s)
- Preeya Gunness
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - Sam Hamilton
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - Robert Capstick
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - John Masters
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - Robert Toma
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
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Pagliara D, Schiavone L, Garganese G, Bove S, Montella RA, Costantini M, Rinaldi PM, Bottosso S, Grieco F, Rubino C, Salgarello M, Ribuffo D. Predicting Mastectomy Skin Flap Necrosis: A Systematic Review of Preoperative and Intraoperative Assessment Techniques. Clin Breast Cancer 2023; 23:249-254. [PMID: 36725477 DOI: 10.1016/j.clbc.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/31/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023]
Abstract
Mastectomy skin-flap necrosis (MSFN) is one of the most feared complications of immediate implant-based breast reconstruction (IIBR). Traditionally, mastectomy skin-flap viability was based only on surgeons' clinical experience. Even though numerous studies have already addressed the patients' risk factors for MSFN, few works have focused on assessing quality of breast envelope. This review investigates mastectomy's flap viability-assessment methods, both preoperative (PMFA) and intraoperative (IMFA), to predict MSFN and its sequalae. Between June and November 2022, we conducted a systematic review of Pubmed/MEDLINE and Cochrane electronic databases. Only English studies regarding PMFA and IMFA applied to IIBR were selected. The use of digital mammography, ultrasound, magnetic resonance imaging, and a combination of several methods before surgery was shown to be advantageous by several authors. Indocyanine performed better than other IMFA, however both thermal imaging and spectroscopy demonstrated novel and promising results. Anyway, the best prediction comes when preoperative and intraoperative values are combined. Particularly in prepectoral reconstruction, when mastectomy flaps are essential to determine a successful breast reconstruction, surgeons' clinical judgment is insufficient in assessing the risk of MSFN. Preoperative and intraoperative assessment techniques play an emerging key role in MSFN prediction. However, although there are several approaches to back up the surgeon's processing choice, there is still a dearth of pertinent literature on the subject, and more research is required.
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Affiliation(s)
- Domenico Pagliara
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy.
| | - Laurenza Schiavone
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Roma, Italy
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Sonia Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Rino Aldo Montella
- Radiology Unit, Mater Olbia Hospital, Mater Olbia Hospital, Olbia, Italy
| | - Melania Costantini
- Radiology Unit, Mater Olbia Hospital, Mater Olbia Hospital, Olbia, Italy
| | | | - Stefano Bottosso
- Department of Medical, Surgical and Health Sciences, Plastic Surgery Unit, University of Trieste, Ospedale di Cattinara, ASUGI, Trieste, Italy
| | - Federica Grieco
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of Sassari, Sassari University Hospital Trust, Sassari, Italy
| | - Corrado Rubino
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of Sassari, Sassari University Hospital Trust, Sassari, Italy
| | - Marzia Salgarello
- Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Diego Ribuffo
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Roma, Italy
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Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management. Cancers (Basel) 2023; 15:cancers15020485. [PMID: 36672434 PMCID: PMC9857053 DOI: 10.3390/cancers15020485] [Citation(s) in RCA: 107] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Obesity or excess body fat is a major global health challenge that has not only been associated with diabetes mellitus and cardiovascular disease but is also a major risk factor for the development of and mortality related to a subgroup of cancer. This review focuses on epidemiology, the relationship between obesity and the risk associated with the development and recurrence of cancer and the management of obesity. METHODS A literature search using PubMed and Google Scholar was performed and the keywords 'obesity' and cancer' were used. The search was limited to research papers published in English prior to September 2022 and focused on studies that investigated epidemiology, the pathogenesis of cancer, cancer incidence and the risk of recurrence, and the management of obesity. RESULTS About 4-8% of all cancers are attributed to obesity. Obesity is a risk factor for several major cancers, including post-menopausal breast, colorectal, endometrial, kidney, esophageal, pancreatic, liver, and gallbladder cancer. Excess body fat results in an approximately 17% increased risk of cancer-specific mortality. The relationship between obesity and the risk associated with the development of cancer and its recurrence is not fully understood and involves altered fatty acid metabolism, extracellular matrix remodeling, the secretion of adipokines and anabolic and sex hormones, immune dysregulation, and chronic inflammation. Obesity may also increase treatment-related adverse effects and influence treatment decisions regarding specific types of cancer therapy. Structured exercise in combination with dietary support and behavior therapy are effective interventions. Treatment with glucagon-like peptide-1 analogues and bariatric surgery result in more rapid weight loss and can be considered in selected cancer survivors. CONCLUSIONS Obesity increases cancer risk and mortality. Weight-reducing strategies in obesity-associated cancers are important interventions as a key component of cancer care. Future studies are warranted to further elucidate the complex relationship between obesity and cancer with the identification of targets for effective interventions.
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Dayaratna N, Nguyen CL, Spillane A, Mak C, Warrier SK, Dusseldorp JR. Trends and variations in post-mastectomy breast reconstruction rates in Australia over 10 years. ANZ J Surg 2023; 93:242-250. [PMID: 36651629 DOI: 10.1111/ans.18243] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Offering breast reconstruction (BR) at the time of mastectomy is standard of care in Australia with proven quality-of-life benefits. Previously BR rates in Australia have been low compared to similar countries. Accurate up-to-date information is needed to promote equity in access to BR and inform future planning of services. This study analysed recent trends and variations of BR uptake in Australia. METHOD Data from the BreastSurgANZ Quality Audit (BQA) were used to identify patients who underwent mastectomy with or without reconstruction for invasive or in situ breast carcinoma from 2010 to 2019. The association between BR uptake and the variables of jurisdiction (state or territory), age, hospital type and remoteness, and remoteness of patients' home addresses were analysed. RESULTS A total 41 880 women underwent mastectomy between 2010 to 2019. The national BR rate steadily increased from 12.8% in 2010 to 29% in 2019, with a 10-year national average of 21.3%. Statistically significant differences in BR uptake (P < 0.001) were found between states with higher rates in New South Wales and Victoria, with BR more likely in private hospitals and in younger women (P < 0.001), and less likely in remote areas (P < 0.001). CONCLUSION The Australian BR rate has increased over the 10-year period, but significant variation still exists between states. BR is lower in older women and those living in regional and remote areas. While the steady increase in BR uptake is encouraging, barriers that exist to equitable provision of reconstructive surgical services for all women living with breast cancer still need to be corrected.
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Affiliation(s)
- Nirmal Dayaratna
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Northern Clinical School, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chu Luan Nguyen
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Andrew Spillane
- Northern Clinical School, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, The Poche Centre, Sydney, New South Wales, Australia.,The Mater Hospital, Sydney, New South Wales, Australia
| | - Cindy Mak
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sanjay Kumar Warrier
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joseph R Dusseldorp
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Plastic Surgery, Concord Repatriation Hospital, Sydney, New South Wales, Australia
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12
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Racial Disparities in Breast Reconstruction at a Comprehensive Cancer Center. J Racial Ethn Health Disparities 2022; 9:2323-2333. [PMID: 34647274 DOI: 10.1007/s40615-021-01169-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Breast reconstruction after a mastectomy is an important component of breast cancer care that improves the quality of life in breast cancer survivors. African American women are less likely to receive breast reconstruction than Caucasian women. The purpose of this study was to further investigate the reconstruction disparities we previously reported at a comprehensive cancer center by assessing breast reconstruction rates, patterns, and predictors by race. METHODS Data were obtained from women treated with definitive mastectomy between 2000 and 2012. Sociodemographic, tumor, and treatment characteristics were compared between African American and Caucasian women, and logistic regression was used to identify significant predictors of reconstruction by race. RESULTS African American women had significantly larger proportions of public insurance, aggressive tumors, unilateral mastectomies, and modified radical mastectomies. African American women had a significantly lower reconstruction rate (35% vs. 49%, p < 0.01) and received a larger proportion of autologous reconstruction (13% vs. 7%, p < 0.01) compared to Caucasian women. The receipt of adjuvant radiation therapy was a significant predictor of breast reconstruction in Caucasian but not African American women. CONCLUSIONS We identified breast reconstruction disparities in rate and type of reconstruction. These disparities may be due to racial differences in sociodemographic, tumor, and treatment characteristics. The predictors of breast reconstruction varied by race, suggesting that the mechanisms underlying breast reconstruction may vary in African American women. Future research should take a target approach to examine the relative contributions of sociodemographic, tumor, and treatment determinants of the breast reconstruction disparities in African American women.
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13
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Smeele HP, Dijkstra RCH, Kimman ML, van der Hulst RRWJ, Tuinder SMH. Patient-Reported Outcome Measures Used for Assessing Breast Sensation after Mastectomy: Not Fit for Purpose. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:435-444. [PMID: 35040096 PMCID: PMC9197899 DOI: 10.1007/s40271-021-00565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/24/2022]
Abstract
AIMS The aims of this review were (i) to evaluate whether patient-reported outcome measures used in clinical studies for assessing sensation after mastectomy and breast reconstruction are suitable for this purpose, and (ii) to explore whether any measures used for assessing sensation after non-oncologic breast surgery are worth modifying for use in post-mastectomy patients. Methods PRISMA guidelines were followed (PROSPERO number CRD42020178066). We searched six databases for studies of oncologic (i.e., therapeutic, prophylactic, and reconstructive) and non-oncologic breast surgery (e.g., breast reduction) in which sensation was assessed with a patient-reported outcome measure. From the selected studies, we extracted eligible measures, evaluated their fitness for purpose, and summarized the content of sensation-specific items. Results Of 6728 articles identified, we selected 135 studies that used 124 eligible patient-reported outcome measures. For 97% of these measures, details regarding development and measurement properties were unavailable. Four (3%) validated measures—the Sensory Disturbances subscale of the Breast Cancer Sequelae Cause Scales, the Discomfort subscale of the Breast Sensation Assessment Scale (BSAS), Didier et al.’s questionnaire for “Assessment of the patients’ satisfaction with cosmetic results, physical and emotional impact of mastectomy”, and the Breast Specific Pain subscale of the Breast Cancer Treatment Outcomes Scale (BCTOS)—each contain at least one item pertaining to breast sensation, but target different concepts of interest. In total, the measures feature 215 sensation-specific items, most of which concern symptom severity (97%) as opposed to impact on daily functioning (3%). Conclusion Patient-reported outcome measures used in clinical studies for assessing sensation after mastectomy and breast reconstruction are unsuitable for this purpose: they are either non-validated or non-specific. We failed to identify any measures for use in non-oncologic breast surgery populations worth modifying. To collect meaningful, patient-relevant data regarding sensation after mastectomy, it is pertinent that future clinical trials adopt psychometrically robust, specific patient-reported outcome measures. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00565-5.
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Affiliation(s)
- Hansje P Smeele
- Department of Plastic, Reconstructive and Hand Surgery, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Rachel C H Dijkstra
- Department of Plastic, Reconstructive and Hand Surgery, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Merel L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Stefania M H Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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14
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Dempsey K, Brennan ME, Spillane A. Inaugural roundtable on breast reconstruction practice in Australia: background, process and recommendations. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Recommendations from the inaugural roundtable on breast reconstruction held on 9 October 2019 in Queensland, Australia, for improved decision-making and increased funding to support wider, timely access to breast reconstruction.
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15
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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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16
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van Egdom LSE, de Ligt KM, de Munck L, Koppert LB, Mureau MAM, Rakhorst HA, Siesling S. Predictors of delayed breast reconstruction in the Netherlands: a 5-year follow-up study in stage I-III breast cancer patients. Breast Cancer 2021; 29:324-335. [PMID: 34780034 PMCID: PMC8885490 DOI: 10.1007/s12282-021-01313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Delayed breast reconstruction (DBR) is a valid option for postmastectomy breast cancer patients who have a desire for breast reconstruction but are not considered suitable for immediate breast reconstruction (IBR). The objective of this study was to investigate the clinical practice and predictors of the use of DBR in the Netherlands. METHODS Stage I-III breast cancer patients diagnosed from January to March 2012 and treated with mastectomy were selected from the Netherlands Cancer Registry. Routinely collected patient, tumor, treatment and hospital characteristics were complemented with data about DBR up to 2018. Multivariable logistic regression analyses were performed to identify factors independently associated with postmastectomy DBR. Factors associated with time to DBR were identified through Cox regression analyses. RESULTS Of all patients who underwent mastectomy (n = 1,415), 10.2% underwent DBR. DBR patients more often received autologous reconstruction compared to IBR patients (37.5% vs 6.2%, p < 0.001). Age below 50 years (age < 35 OR 15.55, age 35-49 OR 4.18) and neoadjuvant and adjuvant chemotherapy (OR 2.59 and OR 2.83, respectively) were significantly associated with DBR. Mean time to DBR was 2.4 years [range 1-6 years]. Time to DBR was significantly associated with age < 35 years (HR 2.22), and a high hospital volume (HR 1.87). DISCUSSION The use of DBR after mastectomy could not be fully explained by age below 50 years, chemotherapy, and hospital volume. Treatment with radiotherapy and adjuvant chemotherapy increased time to DBR. More information about patient preferences is needed to understand the use and timing of reconstruction.
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Affiliation(s)
- L S E van Egdom
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands. .,Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center, P.O. 2040, 3000 CA, Rotterdam, the Netherlands.
| | - K M de Ligt
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L de Munck
- Department of Research and Development, Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center, P.O. 2040, 3000 CA, Rotterdam, the Netherlands
| | - H A Rakhorst
- Department of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - S Siesling
- Department of Research and Development, Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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17
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Patient Perceptions and Determinants of Choice for Breast Reconstruction after Mastectomy among Saudi Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3750. [PMID: 34584821 PMCID: PMC8460226 DOI: 10.1097/gox.0000000000003750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
Background: Undergoing mastectomy is often associated with a negative impact on the mental well-being of patients. Patients who undergo postmastectomy breast reconstruction (BR) have a better self-image and higher self-esteem. Many patients with breast cancer (BC) are unaware of the availability of BR options. This study aimed to assess BC patient perceptions and identify the determinants of patient choices to undergo BR after mastectomy. Methods: This study was conducted between May 10, 2019 and February 29, 2020 via an interview-based questionnaire, among BC patients at King Abdul Aziz University Hospital, Jeddah, Saudi Arabia. Ethical approval was obtained from the research ethics committee before the data collection. Results: Altogether, 400 patients (an overall 82% response rate) were included, of whom 155 (38.75%) were group 1 (willing to undergo BR). The mean age for group 1 was 46.04 ± 8.79, which was younger than for group 2 (unwilling to undergo BR) (P < 0.001). Furthermore, 117 (75.5%) of group 1 had no history of any chronic illness compared with 145 (59.2%) of group 2 (P < 0.001). Group 1 had more knowledge about BR (69.7%, P < 0.001), and the main reason to undergo BR was to regain femininity (26.8%). The remaining patients (31.3%) were unwilling to undergo BR in order to avoid additional surgery. Conclusions: The lack of knowledge and misconception about BR is one factor preventing BC patients from undergoing BR. Spreading awareness and providing accurate information regarding the procedure will allow women with BC to overcome postmastectomy fear.
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18
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Giunta S, Laidsaar-Powell R, Huang L, Hatcher N, Dhillon H, Muscat DM, Carroll S, McNeil C, Burke L, Howson P, Chan B, Juraskova I. Considering the type and timing of breast reconstruction after mastectomy: Qualitative insights into women's decision-making. Eur J Oncol Nurs 2021; 54:102024. [PMID: 34536790 DOI: 10.1016/j.ejon.2021.102024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/05/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The information women receive about the type and timing of breast reconstruction (BR) from healthcare providers is crucial to help them make an informed decision, and this is particularly important in complex cases and/or high-risk cases. This study sought to provide qualitative insights into Australian women's BR decision-making experiences. METHOD Twenty-nine women who had received a mastectomy and made decisions about BR, including the type (expander, implant and/or autologous) and timing (immediate, delayed or immediate-delayed), participated in semi-structured telephone interviews. Interviews were analysed thematically using the Framework method. RESULTS Seven themes were identified: 1) information provision and needs; 2) values and preferences; 3) pressure to decide; 4) feasibility (e.g. clinical and/or financial factors); 5) social influence and support; 6) multidisciplinary team and organisational structures; and 7) decision implementation and outcomes. Breast care nurse support, as well as collaboration and communication within multidisciplinary teams were perceived by women as facilitating the BR decision-making process. CONCLUSIONS The identified themes offer an in-depth explanation of how a sample of Australian women make BR decisions. The current findings highlight the often limited clinician-patient information-sharing and demonstrate the overarching influence of the multidisciplinary medical team and organisational structures on BR decision-making. Development of in-consult decision-aids and strategies to improve multidisciplinary care are discussed.
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Affiliation(s)
- Sarah Giunta
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia
| | - Rebekah Laidsaar-Powell
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia
| | - Lorna Huang
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia
| | - Natasha Hatcher
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia
| | - Haryana Dhillon
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Susan Carroll
- The University of Sydney, Faculty of Medicine and Health Sciences, Sydney Medical School, NSW, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Catriona McNeil
- The University of Sydney, Faculty of Medicine and Health Sciences, Sydney Medical School, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Lucinda Burke
- The University of Sydney, Faculty of Medicine and Health Sciences, Sydney Medical School, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Pamela Howson
- Strathfield Private Hospital, Strathfield, NSW, Australia
| | - Belinda Chan
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Strathfield Private Hospital, Strathfield, NSW, Australia
| | - Ilona Juraskova
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia.
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19
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Couples' Experience of the Decision-Making Process in Breast Reconstruction After Breast Cancer: A Lexical Analysis of Their Discourse. Cancer Nurs 2021; 43:384-395. [PMID: 31033513 DOI: 10.1097/ncc.0000000000000708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND One in 3 women with breast cancer will have a mastectomy and face the decision of whether to have breast reconstruction (BR). This decision is shared by the women and their physician, as well as discussed with her partner. OBJECTIVE This study aimed to understand the decision-making process of BR through a lexical analysis of the women and their partners' discourse. A secondary aim was to identify the differences between the couples when the woman had, or did not have, BR. METHODS We conducted semistructured interviews with 9 women, and their partners, who underwent a mastectomy after a first episode of breast cancer. A lexical analysis using IRaMuTeQ software was carried out. RESULTS The analysis yielded 3 classes, each one being more represented by one of the different BR categories. Class 1 contained words reflecting a preoccupation with body modification. Class 2 was related to the surgery and its consequences. Words contained in class 3 were about the couples' issues regarding surgeries, treatments, and medical care. The question of temporality emerged particularly in classes 2 and 3. CONCLUSIONS This study underlines the differences in the discourse of couples when talking about BR decision-making. Furthermore, it shows the importance of giving women time to think about BR and discuss its issues. IMPLICATION FOR PRACTICE Decisions about BR are difficult to make and should always be discussed between the women and health professionals, as BR is not always possible or desired by women. Partners need to be included in treatment decision-making.
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Perera SK, Jacob S, Sullivan R, Barton M. Evidence-based benchmarks for use of cancer surgery in high-income countries: a population-based analysis. Lancet Oncol 2021; 22:173-181. [PMID: 33485459 DOI: 10.1016/s1470-2045(20)30589-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/31/2020] [Accepted: 09/21/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Estimating a population-level benchmark rate for use of surgery in the management of cancer helps to identify treatment gaps, estimate the survival impact of such gaps, and benchmark the workforce and other resources, including budgets, required to meet service needs. A population-based benchmark for use of surgery in high-income settings to inform policy makers and service provision has not been developed but was recommended by the Lancet Oncology Commission on Global Cancer Surgery. We aimed to develop and validate a cancer surgery benchmarking model. METHODS We examined the latest clinical guidelines from high-income countries (Australia, the UK, the EU, the USA, and Canada) and mapped surgical treatment pathways for 30 malignant cancer sites (19 individual sites and 11 grouped as other cancers) that were notifiable in Australia in 2014, broadly reflecting contemporary high-income models of care. The optimal use of surgery was considered as an indication for surgery where surgery is the treatment of choice for a given clinical scenario. Population-based epidemiological data, such as cancer stage, tumour characteristics, and fitness for surgery, were derived from Australia and other similar high-income settings for 2017. The probabilities across the clinical pathways of each cancer were multiplied and added together to estimate the population-level benchmark rates of cancer surgery, and further validated with the comparisons of observed rates of cancer surgery in the South Western Sydney Local Health District in 2006-12. Univariable and multivariable sensitivity analyses were done to explore uncertainty around model inputs, with mean (95% CI) benchmark surgery rates estimated on the basis of 10 000 Monte Carlo simulations. FINDINGS Surgical treatment was indicated in 58% (95% CI 57-59) of newly diagnosed patients with cancer in Australia in 2014 at least once during the course of their treatment, but varied by site from 23% (17-27) for prostate cancer to 99% (96-99) for testicular cancer. Observed cancer surgery rates in South Western Sydney were comparable to the benchmarks for most cancers, but were higher for some cancers, such as prostate (absolute increase of 29%) and lower for others, such as lung (-14%). INTERPRETATION The model provides a new template for high-income and emerging economies to rationally plan and assess their cancer surgery provision. There are differences in modelled versus observed surgery rates for some cancers, requiring more in-depth analysis of the observed differences. FUNDING University of New South Wales Scientia Scholarship, UK Research and Innovation-Global Challenges Research Fund.
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Affiliation(s)
- Sathira Kasun Perera
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Susannah Jacob
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
| | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia
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21
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Karimi N, Descallar J, Girgis A, Soon PS. Breast reconstruction in South Western Sydney. ANZ J Surg 2020; 90:2340-2345. [PMID: 33021080 DOI: 10.1111/ans.16298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rates of breast reconstruction in Australian patients of culturally and linguistically diverse (CALD) backgrounds are currently unknown. This retrospective study determined the rate of breast reconstruction in women who had mastectomy as treatment for breast cancer at public hospitals in South Western Sydney Local Health District (SWSLHD) - a culturally diverse health district in New South Wales, Australia - and compared the rate of reconstruction in the CALD and non-CALD populations. METHODS The demographic and clinical data of all female patients who had mastectomy with or without reconstruction for treatment of breast cancer at the five public hospitals in SWSLHD between January 2006 and December 2015 were obtained from the clinical information department of each hospital and from electronic medical records. RESULTS The average rate of reconstruction in SWSLHD was 9.4% for 2006-2015. Although the reconstruction rate was higher among English-speaking women (9.9%) compared to women from a CALD background (8.6%), the difference was not statistically significant (P = 0.57). The type (autologous versus implant) and timing (immediate versus delayed) of reconstruction did not differ between groups (P = 0.19 and P = 0.22, respectively). The Index of Relative Socio-Economic Disadvantage was not significantly associated with reconstruction (P = 0.74). However, younger patients were more likely to have reconstruction (P < 0.0001) and patients with adjuvant therapy were more likely to have a delayed reconstruction (P = 0.01). CONCLUSION This study found a low breast reconstruction rate in public hospitals in SWSLHD. The reconstruction rate did not differ between CALD or English-speaking patients, or between patients from diverse socio-economic backgrounds.
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Affiliation(s)
- Neda Karimi
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Patsy S Soon
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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McCamley C, Mills C, Chow Y, Ross D, Fox J. Determinants influencing immediate breast reconstruction in an Australian tertiary public hospital. ANZ J Surg 2020; 90:2334-2339. [PMID: 33021039 DOI: 10.1111/ans.16335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND In Australia, the rate of immediate breast reconstruction (IBR) following breast cancer surgery is highly variable. This study aimed to identify the rate of IBR within an Australian public tertiary breast oncology referral centre and analyse the tumour and demographic factors that impact upon IBR uptake. METHODS A retrospective cohort study of 288 admissions of women requiring mastectomy between January 2012 and March 2015 was performed. Data collected included demographic data, tumour pathology, operative details and neoadjuvant therapy. Demographic data included a Socioeconomic Index for Area score, based on individual residential postcode, country of birth and need for an interpreter. RESULTS Our study demonstrated an IBR rate of 41.3% and included a wide variety of reconstructions. Factors that increased the IBR rate included younger age and negative lymph node status. Our patient population was ethnically and linguistically diverse, with over 50 different countries of birth represented and with 53 patients requiring interpreters in 19 different languages. Our analysis shows that the requirement for an interpreter is negatively correlated with having an IBR. CONCLUSIONS Our research demonstrates a high rate of IBR that includes a wide range of autologous and alloplastic reconstructions. Our study represents a unique opportunity to identify socioeconomic barriers that influence patient choice for reconstruction following mastectomy. This can lead to improved health care provision for our patients. This is particularly important in tertiary services with a strong multicultural and multi-linguistic population.
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Affiliation(s)
- Chere McCamley
- Breast Service, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Christopher Mills
- Department of Surgery, West Gippsland Healthcare Group, Warragul, Victoria, Australia
| | - Yvonne Chow
- Department of Plastics and Reconstructive Surgery, Monash Health, Melbourne, Victoria, Australia
| | - David Ross
- Department of Plastics and Reconstructive Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Jane Fox
- Department of Breast Services, Monash Health, Melbourne, Victoria, Australia.,Faculty of Medicine and Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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23
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Complications in Post-mastectomy Immediate Breast Reconstruction: A Ten-year Analysis of Outcomes. Clin Breast Cancer 2020; 20:402-407. [DOI: 10.1016/j.clbc.2019.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/08/2019] [Accepted: 12/10/2019] [Indexed: 01/07/2023]
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Bajonero-Canonico P, Ferrigno AS, Saldaña-Rodriguez JA, Hinojosa-Gonzalez DE, de la O-Maldonado CG, de la Cruz-de la Cruz C, Moreno-Jaime B, Hernandez-Pavon M, Moral-de la Rubia J, Miaja-Avila M, Villarreal-Garza C. Factors associated with the desire to undergo post-mastectomy breast reconstruction in a Mexican breast cancer center. Support Care Cancer 2020; 29:2679-2688. [PMID: 32975644 DOI: 10.1007/s00520-020-05784-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess the proportion of breast cancer patients treated with total mastectomy who are interested in undergoing breast reconstruction, the factors associated with their desire to undergo this procedure, and the motives stated for their decision. METHODS Women with stage I-III breast cancer, public health insurance, and history of total mastectomy treated at a center in Monterrey, Mexico, were invited to answer a series of questionnaires regarding their clinical and demographic characteristics, information received about breast reconstruction, body image, and relationship satisfaction. RESULTS A total of 100 patients were interviewed, of which 68% desired to undergo breast reconstruction. Only 35% recalled talking about this procedure with a physician and 85% claimed not to have enough information to make an informed decision. Those who desired breast reconstruction were younger (p < 0.001), more likely to be in a relationship (p = 0.025), and had a higher probability of having talked to a physician about the procedure (p = 0.019). Furthermore, they felt less sexually attractive (p < 0.001), more deformed (p = 0.006), and less feminine (p = 0.005) since the mastectomy. The main motives to undergo this procedure were to have breast symmetry and greater freedom on which clothes to wear, while the main deterrent was the high economical cost. CONCLUSIONS Insufficient information about the procedure and high economical cost were identified as potential barriers to undergo breast reconstruction. The findings of this study emphasize the pressing need to optimize patient care by providing information in a standardized manner and improving access to breast reconstruction within the Mexican public healthcare system.
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Affiliation(s)
- Paulina Bajonero-Canonico
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | | | | | | | - Brizio Moreno-Jaime
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Mariela Hernandez-Pavon
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Jose Moral-de la Rubia
- Psychology Department, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Melina Miaja-Avila
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico. .,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico.
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25
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Flitcroft K, Mathieu E, Turner L. Provision of breast reconstruction services in Australia: the case for change. ANZ J Surg 2020; 90:1546-1547. [PMID: 32924300 DOI: 10.1111/ans.15864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/25/2020] [Accepted: 03/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kathy Flitcroft
- Breast and Surgical Oncology at The Poche Centre, Sydney, New South Wales, Australia.,The University of Sydney, Northern Clinical School, Sydney, New South Wales, Australia
| | - Erin Mathieu
- The University of Sydney, School of Public Health, Sydney, New South Wales, Australia
| | - Louise Turner
- Reclaim Your Curves, Sydney, New South Wales, Australia
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26
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Wang J, Xiu B, Guo R, Zhang Q, Su Y, Li L, Chi W, Shao Z, Wu J. Autologous tissue reconstruction after mastectomy-A cross-sectional survey of 110 hospitals in China. Eur J Surg Oncol 2020; 46:2202-2207. [PMID: 32807619 DOI: 10.1016/j.ejso.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 06/11/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Autologous reconstruction after mastectomy became more and more popular, so this study aimed to obtain up-to-date and comprehensive data on autologous reconstruction in China. METHODS An electronic questionnaire was sent to 110 hospitals, which were chosen depending on geographical distribution and hospital types. The questionnaire investigated the demographics, characteristics, breast cancer treatment and reconstruction situation of these hospitals through different modules. We only focused on the autologous breast reconstruction module data. RESULTS 96 hospitals have performed breast reconstruction surgery. The proportion of the hospital performing latissimus dorsi flap (LDF, N = 91), pedicle transverse rectus abdominis myocutaneous flap (pTRAM, N = 62), free abdominal flap (N = 43) and other kinds of flap decreased in sequence. Of the overall reconstruction cases, only 34.3% were autologous reconstruction and LDF was still the most popular option for autologous reconstruction. Related factors of hospital performing different procedures included years of performing breast reconstruction, breast surgical volume, and establishment of an independent plastic surgery department. Compared with LDF, abdominal breast reconstruction was associated with a higher flap necrosis rate. CONCLUSIONS This cross-sectional survey offers real-life autologous reconstruction information on a large population and covers the national surgical landscape in China. Autologous reconstruction is still an important part of breast reconstruction. Nevertheless, its low proportion and lower proportion of abdominal flap reconstruction in each institution, demonstrates that special training should be developed for breast surgeons and multidisciplinary cooperation would be promoted in the future.
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Affiliation(s)
- Jia Wang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Bingqiu Xiu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Rong Guo
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qi Zhang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yonghui Su
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Lun Li
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Weiru Chi
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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27
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Heeg E, Jensen MB, Mureau MAM, Ejlertsen B, Tollenaar RAEM, Christiansen PM, Vrancken Peeters MTFD. Breast-contour preserving procedures for early-stage breast cancer: a population-based study of the trends, variation in practice and predictive characteristics in Denmark and the Netherlands. Breast Cancer Res Treat 2020; 182:709-718. [PMID: 32524354 PMCID: PMC7320958 DOI: 10.1007/s10549-020-05725-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/02/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Breast-contour preservation (BCP) is possible for most women treated for early-stage breast cancer. BCP can be defined as primary breast-conserving treatment (BCT), neoadjuvant chemotherapy (NAC) followed by BCT and immediate postmastectomy breast reconstruction (IBR). This study provides insight in current BCP strategies in Denmark and the Netherlands and aims to identify opportunities for improvement within both countries. METHODS A total of 92,881 patients with early-stage breast cancer who were operated in Denmark and the Netherlands between 2012 and 2017 were selected from the Danish Breast Cancer Group and the Dutch National Breast Cancer Audit databases. BCP procedures and predictive factors were analyzed within and between both countries. RESULTS BCP was achieved in 76.7% (n = 16,355) of the Danish and in 74.5% (n = 53,328) of the Dutch patients. While BCP rate did not change significantly over time in Denmark (p = 0.250), a significant increase in BCP rate from 69.5% in 2012 to 78.5% in 2017 (p < 0.001) was observed in the Netherlands. In both countries, variation in BCP rates between hospitals decreased over time. NAC followed by BCT and postmastectomy IBR was substantially more often used in the Netherlands compared to Denmark, specifically in patients younger than 50 years. CONCLUSIONS In more than 75% of all Danish and Dutch patients, surgically treated for early-stage breast cancer, the breast-contour was preserved. The different use of BCP strategies within Denmark and the Netherlands and the differences observed between hospitals in both countries emphasize the need for more (inter)national consensus on treatment modalities.
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Affiliation(s)
- E Heeg
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands. .,Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - M B Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B Ejlertsen
- Danish Breast Cancer Cooperative Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - R A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - P M Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
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28
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Who, What, Where: Demographics, Severity of Presentation, and Location of Treatment Drive Delivery of Diabetic Limb Reconstructive Services within the National Inpatient Sample. Plast Reconstr Surg 2020; 145:1516-1527. [DOI: 10.1097/prs.0000000000006843] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Marouf A, Mortada H, Fakiha MG. Psychological, sociodemographic, and clinicopathological predictors of breast cancer patients' decision to undergo breast reconstruction after mastectomy. Saudi Med J 2020; 41:267-274. [PMID: 32114599 PMCID: PMC7841554 DOI: 10.15537/smj.2020.3.24946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/16/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To examine the influence of socioeconomic factors, anxiety, depression, and personality traits on the decision to undergo breast reconstruction (BR) post mastectomy. METHODS In this cross-sectional study, adult female breast cancer (BC) patients who had undergone a mastectomy between January 2017 and 2019 were interviewed using a 46-item questionnaire at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The questionnaire was divided into 5 sections: demographic data, personality traits, the Narcissism Index (NI), and the Hospital Anxiety and Depression Scale (HADS). Results: The sample (N=196; mean age: 48.44 [± 9.87] years, opted for BR: 60.2%, with chronic diseases: 36.7%, Saudi nationals: 43.9%) obtained means of 4.17 (± 2.81) on NI score, 7.72 (± 4.88) on anxiety score, and 5.78 (± 4.65) on depression score. Group differences in age, depression, lymph node involvement, and 2 personality traits emerged. CONCLUSION Age and depression significantly influenced the decision to undergo BR. Women who had opted for BR tended to be younger, be less depressed, and be characterized by lesser nodal involvement. Personality traits also influenced the decision to undergo BR. Diagnosing and treating depressed patients is an important component. A patient's age should not deter physicians from counselling them about BR.
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Affiliation(s)
- Azmi Marouf
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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30
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Siotos C, Lagiou P, Cheah MA, Bello RJ, Orfanos P, Payne RM, Broderick KP, Aliu O, Habibi M, Cooney CM, Naska A, Rosson GD. Determinants of receiving immediate breast reconstruction: An analysis of patient characteristics at a tertiary care center in the US. Surg Oncol 2020; 34:1-6. [PMID: 32103789 DOI: 10.1016/j.suronc.2020.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/14/2020] [Accepted: 02/14/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast reconstruction is an option for women undergoing mastectomy for breast cancer. Previous studies have reported underutilization of reconstructive surgery. This study aims to examine the role demographic, clinical and socio-economic factors may have on patients' decisions to undergo breast reconstruction. METHODS We analyzed data from our institutional database. Using multivariable and multinomial logistic regression, we compared breast cancer patients who had undergone mastectomy-only to those who had immediate breast reconstruction (overall and by type of reconstruction). RESULTS We analyzed data on 1459 women who underwent mastectomy during the period 2003-2015. Of these, 475 (32.6%) underwent mastectomy-only and 984 (67.4%) also underwent immediate breast reconstruction. After adjusting for potential confounders, older age (OR = 0.18, 95%CI:0.08-0.40), Asian race (OR = 0.29, 95%CI:0.19-0.45), bilateral mastectomy (OR = 0.71, 95%CI:0.56-0.90), and higher stage of disease (OR = 0.44, 95%CI:0.26-0.74) were independent risk factors for not receiving immediate breast reconstruction. Furthermore, patients with Medicare or Medicaid insurance were less likely than patients with private insurance to receive an autologous reconstruction. There was no evidence for changes over time in the way socio-demographic and clinical factors were related to receiving immediate breast reconstruction after mastectomy. CONCLUSIONS Clinical characteristics, sociodemographic factors like age, race and insurance coverage affect the decision for reconstructive surgery following mastectomy.
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Affiliation(s)
- Charalampos Siotos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287.
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece
| | - Michael A Cheah
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Ricardo J Bello
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287; Department of Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Phillipos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece
| | - Rachael M Payne
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Kristen P Broderick
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Oluseyi Aliu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Androniki Naska
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece
| | - Gedge D Rosson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
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31
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Heilat GB, Brennan ME, Kanesalingam K, Sriram N, Meybodi F, French J. Presentation, tumour and treatment features in immigrant women from Arabic-speaking countries treated for breast cancer in Australia. ANZ J Surg 2019; 90:325-331. [PMID: 31845467 DOI: 10.1111/ans.15596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/27/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Australia has a large population of immigrant women from Arabic-speaking countries. The aim of this study was to examine breast cancer tumour and surgical treatment features for women born in Arabic-speaking countries and compare them to women born in Australia and other countries. Another aim was to consider how this information can inform clinical care for this multicultural population. METHODS This is a retrospective audit of an institutional breast cancer database. Demographic, tumour and surgical treatment data were extracted for the Arab women and compared to Australian-born women (comparison 1) and to women born in all other countries (comparison 2); chi-squared analysis was performed to test for differences between groups. RESULTS A total of 2086 cases with country of birth information were identified, of whom 139 women (6.7%) were born in Arabic-speaking countries, 894 (42.8%) were born in Australia and 1053 (50.4%) were born in other countries (71 nations). Arab women tended to be younger (P = 0.013), more disadvantaged (P < 0.001), were more likely to have symptomatic rather than screen-detected breast cancer (P < 0.001), had a higher rate of high grade (P = 0.021), HER2-positive (P = 0.025) breast cancer compared to Australian-born women or others. There was no difference in tumour (pT) stage, rate of breast conservation versus mastectomy, re-excision and contralateral prophylactic mastectomy between groups. Australian-born women were more likely to undergo breast reconstruction after mastectomy (P < 0.001); reconstruction rate was >29% in all groups. CONCLUSION Women born in Arabic-speaking countries were younger, more disadvantaged and showed more aggressive tumour features. This has implications for supportive care during treatment and survivorship.
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Affiliation(s)
- Ghaith B Heilat
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Meagan E Brennan
- Northern and Western Clinical Schools, The University of Sydney, Sydney, New South Wales, Australia
| | - Kavitha Kanesalingam
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Nina Sriram
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Farid Meybodi
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - James French
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
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32
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Survival and Disease Recurrence Rates among Breast Cancer Patients following Mastectomy with or without Breast Reconstruction. Plast Reconstr Surg 2019; 144:169e-177e. [PMID: 31348330 DOI: 10.1097/prs.0000000000005798] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Concerns have been expressed about the oncologic safety of breast reconstruction following mastectomy for breast cancer. This study aimed to evaluate the association of breast reconstruction with breast cancer recurrence, and 5-year survival among breast cancer patients. METHODS The authors analyzed data from The Johns Hopkins Hospital comprehensive cancer registry, comparing mastectomy-only to postmastectomy breast reconstruction in breast cancer patients to evaluate differences in breast cancer recurrence and 5-year survival. Kaplan-Meier curves were used to compare unadjusted estimates of survival or disease recurrence. Data were modeled through Cox proportional hazards regression, using as outcomes time to death from any cause or time to cancer recurrence. RESULTS The authors analyzed data on 1517 women who underwent mastectomy for breast cancer at The Johns Hopkins hospital between 2003 and 2015. Of these, 504 (33.2 percent) underwent mastectomy only and 1013 (66.8 percent) underwent mastectomy plus immediate breast reconstruction. Women were followed up for a median of 5.1 years after diagnosis. There were 132 deaths and 100 breast cancer recurrences. A comparison of Kaplan-Meier survival estimates demonstrated a survival benefit among patients undergoing mastectomy plus reconstruction. After adjusting for various clinical and socioeconomic variables, there was still an overall survival benefit associated with breast reconstruction which, however, was not statistically significant (hazard ratio, 0.78; 95 percent CI, 0.53 to 1.13). Patients who underwent reconstruction had a similar rate of recurrence compared to mastectomy-only patients (hazard ratio, 1.08; 95 percent CI, 0.69 to 1.69). CONCLUSION This study suggests that breast reconstruction does not have a negative impact on either overall survival or breast cancer recurrence rates. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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33
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Feng Y, Flitcroft K, van Leeuwen MT, Elshaug AG, Spillane A, Pearson SA. Patterns of immediate breast reconstruction in New South Wales, Australia: a population-based study. ANZ J Surg 2019; 89:1230-1235. [PMID: 31418524 PMCID: PMC6852512 DOI: 10.1111/ans.15381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Abstract
Background The rate of immediate breast reconstruction (IBR) following mastectomy for breast cancer in Australia is low and varies between regions. To date, no previous Australian studies have examined IBR rates between all hospitals within a particular jurisdiction, despite hospitals being an important known contributor to variation in IBR rates in other countries. Methods We used cross‐classified random‐effects logistic regression models to examine the inter‐hospital variation in IBR rates by using data on 7961 women who underwent therapeutic mastectomy procedures in New South Wales (NSW) between January 2012 and June 2015. We derived IBR rates by patient‐, residential neighbourhood‐ and hospital‐related factors and investigated the underlying drivers for the variation in IBR. Results We estimated the mean IBR rate across all hospitals performing mastectomy to be 17.1% (95% Bayesian credible interval (CrI) 12.1–23.1%) and observed wide inter‐hospital variation in IBR (variance 4.337, CrI 2.634–6.889). Older women, those born in Asian countries (odds ratio (OR) 0.5, CrI 0.4–0.6), residing in neighbourhoods with lower socioeconomic status (OR 0.7, CrI 0.5–0.8 for the most disadvantaged), and who underwent surgery in public hospitals (OR 0.4, CrI 0.1–1.0) were significantly less likely to have IBR. Women residing in non‐metropolitan areas and attending non‐metropolitan hospitals were significantly less likely to undergo IBR than their metropolitan counterparts attending metropolitan hospitals. Conclusion Wide inter‐hospital variation raises concerns about potential inequities in access to IBR services and unmet demand in certain areas of NSW. Explaining the underlying drivers for IBR variation is the first step in identifying policy solutions to redress the issue.
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Affiliation(s)
- Yingyu Feng
- Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kathy Flitcroft
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia
| | - Marina T van Leeuwen
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Adam G Elshaug
- Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Spillane
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia.,Breast and Melanoma Surgery Units, The Mater Hospital, Sydney, New South Wales, Australia.,Breast and Melanoma Surgery Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Big Data Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
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34
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Quemener J, Wallet J, Boulanger L, Hannebicque K, Chauvet M, Régis C. Decision‐making determinants for breast reconstruction in women over 65 years old. Breast J 2019; 25:1235-1240. [DOI: 10.1111/tbj.13438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | - Claudia Régis
- Department of Surgery Centre Oscar Lambret Lille France
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Angarita FA, Dossa F, Zuckerman J, McCready DR, Cil TD. Is immediate breast reconstruction safe in women over 70? An analysis of the National Surgical Quality Improvement Program (NSQIP) database. Breast Cancer Res Treat 2019; 177:215-224. [PMID: 31154580 DOI: 10.1007/s10549-019-05273-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The safety of immediate breast reconstruction (IBR) in older women is largely unknown. This study aimed to determine the 30-day postoperative complication rates following IBR (implant-based or autologous) in older women (≥ 70 years) with breast cancer and to compare them to younger women (18-69 years). METHODS The National Surgical Quality Improvement Program (NSQIP) database was used to identify women with in situ or invasive breast cancer who underwent IBR (2005-2016). Outcomes included 30-day postoperative morbidity and mortality, which were compared across age groups stratified by type of reconstruction. RESULTS Of 28,850 women who underwent implant-based and 9123 who underwent autologous reconstruction, older women comprised 6.5% and 5.7% of the sample, respectively. Compared to younger women, older women had more comorbidities, shorter operative times, and longer length of hospital stay. In the implant-based reconstruction group, the 30-day morbidity rate was significantly higher in older women (7.5% vs 5.3%, p < 0.0001) due to higher rates of infectious, pulmonary, and venous thromboembolic events. Wound morbidity and prosthesis failure occurred equally among age groups. In the autologous reconstruction group, there was no statistically significant difference in the 30-day morbidity rates (older 9.5% vs younger 11.6%, p = 0.15). Both wound morbidity and flap failure rates were similar between the two age groups. For both reconstruction techniques, mortality within 30 days of breast surgery was rare. CONCLUSION Immediate breast reconstruction is safe in older women. These data support the notion that surgeons should discuss IBR as a safe and integral part of cancer treatment in well-selected older women.
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Affiliation(s)
- Fernando A Angarita
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Fahima Dossa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jesse Zuckerman
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - David R McCready
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Tulin D Cil
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. .,Department of Surgery, Women's College Hospital, Toronto, ON, Canada. .,Division of General Surgery, University Health Network, 610 University Ave, OPG- 6th Floor, Toronto, ON, M5G 2M9, Canada.
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Yin Z, Wang Y, Sun J, Huang Q, Liu J, He S, Han C, Wang S, Ding B, Yin J. Association of sociodemographic and oncological features with decision on implant-based versus autologous immediate postmastectomy breast reconstruction in Chinese patients. Cancer Med 2019; 8:2223-2232. [PMID: 30950238 PMCID: PMC6536967 DOI: 10.1002/cam4.2133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/13/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022] Open
Abstract
Background and objectives Immediate postmastectomy breast reconstruction (IPBR) has gained wide popularity in China. We sought to clarify the prevalence and predictors of implant‐based vs autologous IPBR among Chinese patients. Methods A retrospective cohort study was performed using a prospectively maintained database. Women who underwent IPBR during 2001‐2017 were included. The modality‐specific trends were deciphered by curve fitting analysis. The association of sociodemographic and oncological features with the decision for implant‐based vs autologous IPBR was investigated using multivariate logistic regression and structural equation modeling. Results Among 905 patients included in the study, 479 underwent implant‐based IPBR and 426 underwent autologous procedures. The implant/autologous ratio has increased exponentially over time. Multivariate analysis demonstrated that unmarried patients with BMI ≤ 24 kg/m2, earlier clinical tumor stage, and preoperative pathological diagnosis of noninvasive lesion are more likely to choose implant‐based IPBR compared to autologous procedures. The indirect effects of age, mastectomy type, and neoadjuvant chemotherapy were further demonstrated by the structural equations. Conclusions The sociodemographic and oncological features are directly or indirectly associated with the decision on type of IPBR. The findings may facilitate both patients and physicians to make a high‐quality decision by holistic evaluation of the sociodemographic and oncological features.
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Affiliation(s)
- Zhuming Yin
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Yan Wang
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Jingyan Sun
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Qingfeng Huang
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Jing Liu
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Shanshan He
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Chunyong Han
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Shu Wang
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Bowen Ding
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Jian Yin
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
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Saveliyev VN, Tkachev MV, Borisov AP. [The method of endoprosthesis deployment in breast cancer surgery]. Khirurgiia (Mosk) 2019:50-52. [PMID: 30789608 DOI: 10.17116/hirurgia201901150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To improve immediate results of treatment in patients with breast cancer using a new method of reconstruction. MATERIAL AND METHODS Prospective study included 215 patients with breast cancer. Patients were treated at the Samara Regional Clinical Oncology Center in 2013-2016. Patients of the control group (n=111) underwent subcutaneous mastectomy followed by conventional endoprosthesis deployment with its complete muscular covering. Patients of the main group (n=104) underwent subcutaneous mastectomy with a new method of single-stage reconstruction. RESULTS Mean time of operation was 115±15 min in the control group and 90±10 min in the main group (p=0.000). Intraoperative blood loss reached 115±15 ml in the control group, 70±10 ml - in the main group (p=0.000). Duration of postoperative lymphorrhea was 14.6±3.5 days in the control group, 10±3.4 days - in the main group (p=0.000). Postoperative hospital-stay was 17.1±3.7 day in the control group and 14.2±2.4 days in the main group (p=0.001). CONCLUSION New surgical approach significantly improves early outcomes in patients with breast cancer in comparison with those who undergo conventional surgical repair.
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Affiliation(s)
- V N Saveliyev
- Samara Regional Clinical Oncology Center, Samara, Russia
| | - M V Tkachev
- Samara Regional Clinical Oncology Center, Samara, Russia
| | - A P Borisov
- Samara Regional Clinical Oncology Center, Samara, Russia
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McKevitt E, Kuusk U, Dingee C, Warburton R, Pao JS, Van Laeken NY, Bovill ES. Immediate Reconstruction Swing Room Scheduling Reduces Wait Times to Surgery and Increases Breast Reconstruction Rates. Ann Surg Oncol 2019; 26:1276-1283. [PMID: 30756328 DOI: 10.1245/s10434-019-07216-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite benefits in quality of life, patient satisfaction, overall healthcare costs, and number of surgeries, historically fewer than 30% of patients undergo immediate breast reconstruction following mastectomy for breast cancer. A paucity of qualified oncologic and plastic surgeons coupled with inefficient use of operating room (OR) resources presents challenges in offering immediate breast reconstruction in a timely manner. To address these challenges, an immediate reconstruction swing room (IRSW) program was developed. METHODS IRSW scheduling leverages two concurrently running ORs, with the surgical oncologist and plastic surgeon moving between rooms to complete 2-4 combined mastectomy cases with immediate reconstruction, in addition to 1-2 independent cases, each operative day. The final year of traditional booking was compared with IRSW scheduling to assess wait times and reconstruction rates. RESULTS Comparing the 2 years, fewer surgical breast cases were performed with IRSW scheduling (1250 vs. 1178), however the overall number of oncology cases increased from 735 (59%) to 857 (73%). The number of immediate reconstructions performed increased from 75 to 139 (p < 0.0001), which reflects a mean of 1.2 IR cases versus 2.9 combined cases in IRSW. Overall, this facilitated an increase in the rate of immediate reconstruction following therapeutic mastectomy from 35 to 49% (p = 0.0004) and decreased wait times from core biopsy to surgery from 70 to 52 days (p < 0.0001). CONCLUSIONS A multidisciplinary model with optimized scheduling has the potential to improve resource utilization and access to breast cancer care.
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Affiliation(s)
- Elaine McKevitt
- Department of Surgery, Providence Breast Center, Vancouver, BC, Canada. .,Department of Surgery, The University of British Columbia, Vancouver, BC, Canada.
| | - Urve Kuusk
- Department of Surgery, Providence Breast Center, Vancouver, BC, Canada.,Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Carol Dingee
- Department of Surgery, Providence Breast Center, Vancouver, BC, Canada.,Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Warburton
- Department of Surgery, Providence Breast Center, Vancouver, BC, Canada.,Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Jin-Si Pao
- Department of Surgery, Providence Breast Center, Vancouver, BC, Canada.,Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Nancy Y Van Laeken
- Department of Surgery, Providence Breast Center, Vancouver, BC, Canada.,Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Esta S Bovill
- Department of Surgery, Providence Breast Center, Vancouver, BC, Canada.,Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
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Variations in the breast reconstruction rate in France: A nationwide study of 19,466 patients based on the French medico-administrative database. Breast 2018; 42:74-80. [DOI: 10.1016/j.breast.2018.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/02/2018] [Accepted: 07/22/2018] [Indexed: 01/29/2023] Open
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Gong F, Ding L, Chen X, Yao D, Wu Y, Xie L, Ouyang Q, Wang P, Niu G. Degree of Acceptance of Breast Reconstruction and the Associated Factors Among a Population of Chinese Women with Breast Cancer. Aesthetic Plast Surg 2018; 42:1499-1505. [PMID: 29948098 DOI: 10.1007/s00266-018-1171-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Breast cancer is one of the most common female "malignancies" reported worldwide in recent years. This study is aimed to understand the degree of acceptance of breast reconstruction among breast cancer patients in Chinese women and to explore the related factors. METHODS Breast cancer patients were asked to fill in the demographic questionnaire, and consent for evaluation of Breast Reconstruction Acceptance Scale, Social Support Scale, and Functional Assessment of Cancer Therapy-breast Quality of Life Instrument (FACT-B). The data were assessed using multivariate logistic regression analysis for the correlations between the degree of acceptance of breast reconstruction and age, marital status, family monthly income, quality of life, and social support. RESULTS 57.5% of 715 patients were not familiar with breast reconstruction. Results showed correlation with the degree of acceptance of breast reconstruction. Multivariate analysis indicated that age (41-50 years old, OR: 0.25, 95% CI: 0.08-0.76; > 50, OR: 0.05, 95% CI: 0.02-0.15), marital status (married, OR: 0.15, 95% CI: 0.05-0.43; divorced/widowed, OR: 0.11, 95% CI: 0.03-0.42), family income (3-10 thousand RMB, OR: 2.01, 95% CI: 1.08-3.76; > 10 thousand RMB, OR: 2.14, 95% CI: 1.05-4.37), quality of life (fair, OR: 0.59, 95% CI: 0.39-0.91), and social support (excellent, OR: 0.50, 95% CI: 0.30-0.83) were all correlated with the degree of acceptance of breast reconstruction. CONCLUSION Chinese breast cancer patients have a low degree of acceptance of breast reconstruction. The degree of acceptance was found to be correlated with age, marital status, family monthly income, quality of life, and social support. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Discrepancies Between Surgical Oncologists and Plastic Surgeons in Patient Information Provision and Personal Opinions Towards Immediate Breast Reconstruction. Ann Plast Surg 2018; 81:383-388. [DOI: 10.1097/sap.0000000000001572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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The satisfaction of patients with breast cancer undergone immediate reconstruction with implant and the effect of radiotherapy. Contemp Oncol (Pozn) 2018; 22:27-30. [PMID: 29692660 PMCID: PMC5909727 DOI: 10.5114/wo.2018.74390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/04/2018] [Indexed: 11/17/2022] Open
Abstract
Aim of the study Postmastectomy reconstructive surgery for cosmetic satisfaction of patients is rapidly increasing. Postoperative complications such as infection, capsular contracture, implant loss are more common in patients who receive adjuvant radiotherapy (RT) than those who do not. Satisfaction levels in patients is still a controversial issue. Therefore, we wanted to investigate our patient population for the effects of RT and planned a study evaluating the satisfaction rates of our patients who received implants. Material and methods Seventy five breast cancer patients who went through mastectomy and went through reconstruction using expanders or silicone implants were surveyed. Complication and cosmetic satisfaction rates were separately compared between irradiated and nonirradiated implants. Responses of 46 patients who answered the survey were analyzed using χ2 test and Mann Whitney U test. p < 0.05 was considered statistically significant. Results Thirty-one of the patients received adjuvant RT and 15 did not receive RT (NRT). There was no difference between the RT and NRT groups in the terms of touch, size, shape of silicones, pain and satisfaction level in look of clothing. Only satisfaction in symmetry was significantly lower in the RT group than in the NRT group (p = 0.02). Additionally, patients receiving chemotherapy were less satisfied with silicone size than those who did not (p = 0.02). Conclusion We did not find negative effects, other than symmetry, of adjuvant radiotherapy in breast cancer patients who underwent reconstructive surgery in terms of cosmetic satisfaction.
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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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Cornelissen AJM, Beugels J, van Kuijk SMJ, Heuts EM, Rozen SM, Spiegel AJ, van der Hulst RRWJ, Tuinder SMH. Sensation of the autologous reconstructed breast improves quality of life: a pilot study. Breast Cancer Res Treat 2017; 167:687-695. [PMID: 29071492 PMCID: PMC5807496 DOI: 10.1007/s10549-017-4547-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/16/2017] [Indexed: 11/04/2022]
Abstract
Purpose The number of breast cancer survivors continues to grow. Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. Impaired sensation remains a debilitating side effect with a significant impact on the quality of life. Microsurgical nerve coaptation of a sensory nerve has the potential to improve sensation of the reconstructed breast. This study investigates the effect of improved sensation of the reconstructed breast on the quality of life in breast cancer survivors. Methods A retrospective cohort study was performed in the Maastricht University Medical Center. Patients undergoing a DIEP flap breast reconstruction between January 2015 and January 2016 were included. The primary outcome was quality of life (BREAST-Q domain ‘physical well-being of the chest’). The Semmes–Weinstein monofilaments were used for objective sensation measurement of the reconstructed breast(s). Results Eighteen patients with and 14 patients without nerve coaptation responded. Nipple reconstruction was the only characteristic that differed statistically significant between both groups (p = 0.04). The BREAST-Q score for the domain physical well-being of the chest was 77.89 ± 18.89 on average in patients with nerve coaptation and 66.21 ± 18.26 in patients without nerve coaptation (p = 0.09). Linear regression showed a statistically significant relation between objectively measured sensation and BREAST-Q score for the domain physical well-being of the chest with a regression coefficient of − 13.17 ± 3.61 (p < 0.01). Conclusions Improved sensation in the autologous reconstructed breast, with the addition of microsurgical nerve coaptation, has a statistical significant positive impact on the quality of life in breast cancer survivors according to the BREAST-Q.
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Affiliation(s)
- Anouk J M Cornelissen
- Department of Plastic Surgery, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Jop Beugels
- Department of Plastic Surgery, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Esther M Heuts
- Department of Surgery, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Shai M Rozen
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX, 75390, USA
| | - Aldona J Spiegel
- Division of Plastic Surgery, Houston Methodist Hospital, 6565 Fannin St, Houston, TX, 77030, USA
| | - René R W J van der Hulst
- Department of Plastic Surgery, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Stefania M H Tuinder
- Department of Plastic Surgery, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
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Lee CNH, Deal AM, Huh R, Ubel PA, Liu YJ, Blizard L, Hunt C, Pignone MP. Quality of Patient Decisions About Breast Reconstruction After Mastectomy. JAMA Surg 2017; 152:741-748. [PMID: 28467530 DOI: 10.1001/jamasurg.2017.0977] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Breast reconstruction has the potential to improve a person's body image and quality of life but has important risks. Variations in who undergoes breast reconstruction have led to questions about the quality of patient decisions. Objective To assess the quality of patient decisions about breast reconstruction. Design, Setting, and Participants A prospective, cross-sectional survey study was conducted from June 27, 2012, to February 28, 2014, at a single, academic, multidisciplinary oncology clinic among women planning to undergo mastectomy for stage I to III invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis. Exposures Mastectomy only and mastectomy with reconstruction. Main Outcome and Measures Knowledge, as ascertained using the Decision Quality Instrument; preference concordance, based on rating and ranking of key attributes; and decision quality, defined as having knowledge of 50% or more and preference concordance. Results During the 20-month period, 214 patients were eligible, 182 were approached, and 32 missed. We enrolled 145 patients (79.7% enrollment rate), and received surveys from 131 patients (72.0% participation rate). Five participants became ineligible. The final study population was 126 patients. Among the 126 women in the study (mean [SD] age, 53.2 [12.1] years), the mean (SD) knowledge score was 58.5% (16.2%) and did not differ by treatment group (mastectomy only, 55.2% [15.0%]; mastectomy with reconstruction, 60.5% [16.5%]). A total of 82 of 123 participants (66.7%) had a calculated treatment preference of mastectomy only; 39 of these women (47.6%) underwent mastectomy only. A total of 41 participants (32.5%) had a calculated treatment preference of mastectomy with reconstruction; 36 of these women (87.8%) underwent mastectomy with reconstruction. Overall, 52 of 120 participants (43.3%) made a high-quality decision. In multivariable analysis, white race/ethnicity (odds ratio [OR], 2.72; 95% CI, 1.00-7.38; P = .05), having private insurance (OR, 1.61; 95% CI, 1.35-1.93; P < .001), having a high school education or less (vs some college) (OR, 4.84; 95% CI, 1.22-19.21; P = .02), having a college degree (vs some college) (OR, 1.95; 95% CI, 1.53-2.49; P < .001), and not having a malignant neoplasm (eg, BRCA carriers) (OR, 3.13; 95% CI, 1.25-7.85; P = .01) were independently associated with making a high-quality decision. Conclusions and Relevance A minority of patients undergoing mastectomy in a single academic center made a high-quality decision about reconstruction. Shared decision making is needed to support decisions about breast reconstruction.
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Affiliation(s)
- Clara Nan-Hi Lee
- Department of Plastic Surgery, College of Medicine, The Ohio State University, Columbus.,Richard J. Solove Research Institute, Comprehensive Cancer Center-Arthur G. James Cancer Hospital, The Ohio State University, Columbus.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina-Chapel Hill
| | - Ruth Huh
- Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina-Chapel Hill
| | - Peter Anthony Ubel
- Duke-Margolis Center for Health Policy, Fuqua School of Business, Duke University, Durham, North Carolina.,Duke-Margolis Center for Health Policy, Sanford School of Public Policy, Duke University, Durham, North Carolina.,Duke-Margolis Center for Health Policy, Duke University School of Medicine, Durham, North Carolina
| | - Yuen-Jong Liu
- Department of Surgery, University of North Carolina Hospitals, University of North Carolina-Chapel Hill
| | - Lillian Blizard
- Gastrointestinal Unit, Massachusetts General Hospital, Boston
| | - Caprice Hunt
- Department of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina-Chapel Hill
| | - Michael Patrick Pignone
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin.,Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
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Mahmoudi E, Lu Y, Metz AK, Momoh AO, Chung KC. Association of a Policy Mandating Physician-Patient Communication With Racial/Ethnic Disparities in Postmastectomy Breast Reconstruction. JAMA Surg 2017; 152:775-783. [PMID: 28564674 DOI: 10.1001/jamasurg.2017.0921] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance With the stabilization of breast cancer incidence and substantial improvement in survival, more attention has focused on postmastectomy breast reconstruction (PBR). Despite its demonstrated benefits, wide disparities in the use of PBR remain. Physician-patient communication has an important role in disparities in health care, especially for elective surgical procedures. Recognizing this, the State of New York enacted Public Health Law (NY PBH Law) 2803-o in 2011 mandating that physicians communicate about reconstructive surgery with patients undergoing mastectomy. Objective To evaluate whether mandated physician-patient communication is associated with reduced racial/ethnic disparities in immediate PBR (IPBR). Design, Setting, and Participants This retrospective study used state inpatient data from January 1, 2008, through December 31, 2011, in New York and California to evaluate a final sample of 42 346 women aged 20 to 70 years, including 19 364 from New York (treatment group) and 22 982 from California (comparison group). The primary hypothesis tested the effect of the New York law on racial/ethnic disparities, using California as a comparator. The National Academy of Medicine's (formerly Institute of Medicine) definition of a disparity was applied, and a difference-in-differences method (before-and-after comparison design) was used to evaluate the association of NY PBH Law 2803-o mandating physician-patient communication with disparities in IPBR. Data were analyzed from July 1, 2016, to February 24, 2017. Exposures New York PBH Law 2803-o was implemented on January 1, 2011. The preexposure period included January 1, 2008, through December 31, 2010 (3 years); the postexposure period, January 1 through December 31, 2011 (1 year). Main Outcomes and Measures The primary outcome was use of IPBR among white, African American, Hispanic, and other minority groups before and after the implementation of NY PBH Law 2803-o. Results Among the 42 346 women (mean [SD] age, 53 [10] years), 65.3% (27 654) were white, 12.7% (5365) were Hispanic, 9.4% (3976) were African American, and 12.6% (5351) were other minorities. The new legislation was not associated with the overall IPBR rate or disparity in IPBR between whites and African Americans (reduction of 1 percentage point; 95% CI, -0.02 to 0.04), but it was associated with a reduction in disparities in IPBR between Hispanic and white patients by 9 (95% CI, 0.06-0.11) percentage points and between other minorities and white patients by 13 (95% CI, 0.11-0.16) percentage points. Conclusions and Relevance Physician-patient communication may help to address inequity in the use of elective surgical procedures, such as IPBR. However, lack of patient trust and/or effective physician-patient communication may reduce the potential effect of mandatory communication for some subpopulations, including African American individuals.
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Affiliation(s)
- Elham Mahmoudi
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor
| | - Yiwen Lu
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor
| | - Allan K Metz
- Office of Health Equity and Inclusion, Michigan Health Science Undergraduate Research Academy, University of Michigan, Ann Arbor.,currently an undergraduate student at Youngstown State University, Youngstown, Ohio
| | - Adeyiza O Momoh
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor
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James J, Corrigan B, Saunders C. Pre-hydrated sterile acellular dermal matrix allograft in breast reconstruction: review of a single unit's experience. ANZ J Surg 2017; 88:369-373. [PMID: 28727237 DOI: 10.1111/ans.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The acellular dermal matrix (Flex HD) (FHD) became available for use in Western Australia in 2014 to aid prosthetic breast reconstruction and this descriptive study aims to review and discuss a single institution's experience since its introduction. METHODS By retrospective case note, review data were collected for all patients who underwent prosthetic breast reconstruction with the aid of FHD between January 2014 and August 2015 in our institution. Data on basic demographic parameters, risk factors, surgery-related factors, post-operative factors and follow-up information were collected. All complications were recorded and described in detail. RESULTS FHD was used in 42 breast reconstructions in 26 patients. Procedure-related complications were seen in 26% (n = 11) of cases. A major complication requiring return to theatre was seen in 11% (n = 5) of cases. Cellulitis of the reconstructed breast (red breast syndrome) was seen in 16.67% (n = 7) cases. Overall implant loss was 2.4% (n = 1). Of the six possible risk factors for any complication, only current smoking was found to increase the risk of complications (odds ratio = 9.667, 95% confidence interval = 1.429-65.377). CONCLUSION FHD is associated with a relatively high overall complication rate. Use of this optional expensive material has to be carefully selected balancing its perceived advantages against this possible risk. The red breast syndrome merits further studies considering its frequent occurrence with FHD use.
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Affiliation(s)
- Justin James
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Brigid Corrigan
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Plastic and Reconstructive Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Christobel Saunders
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Surgery, The University of Western Australia, Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Oliveras I, Losilla JM, Vives J. Methodological quality is underrated in systematic reviews and meta-analyses in health psychology. J Clin Epidemiol 2017; 86:59-70. [DOI: 10.1016/j.jclinepi.2017.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/09/2016] [Accepted: 05/02/2017] [Indexed: 01/09/2023]
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El Gammal MM, Lim M, Uppal R, Sainsbury R. Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting. BREAST CANCER-TARGETS AND THERAPY 2017; 9:293-296. [PMID: 28496361 PMCID: PMC5417655 DOI: 10.2147/bctt.s133800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction The National Institute for Health and Clinical Excellence guidelines recommend that breast reconstruction should be available to all women undergoing mastectomy and discussed at the initial surgical consultation (2002, and updated 2009). The National Mastectomy and Breast Reconstruction Audit (2009) showed that 21% of mastectomy patients underwent immediate breast reconstruction (IBR) and 11% had delayed breast reconstruction (DBR). Breast reconstruction has been shown to have a positive effect on quality of life postmastectomy. This retrospective study investigated the impact of the introduction of a dedicated oncoplastic multidisciplinary meeting (OP MDM) on our unit’s breast reconstruction rate. Patients and methods A retrospective analysis of 229 women who underwent mastectomy, of whom 81 (35%) underwent breast reconstruction between April 2014 and March 2016. Data were analyzed before and after introduction of OP MDM in April 2015. Data on patient age, type of surgery (mastectomy only, mastectomy and reconstruction), timing of reconstruction (IBR, DBR), and type of reconstruction (implant, autologous) were collected. Results Between April 2015 and March 2016, following establishment of OP multidisciplinary team in April 2015, of the 120 patients who had mastectomy, 50 (42%) underwent breast reconstruction with 78% (39/50) choosing IBR (56% implant reconstruction and 22% autologous). Compared to the period between April 2014 and March 2015 preceding the OP MDM, of 109 patients who underwent mastectomy, only 31 (28%) had breast reconstruction with 64% (20/31) choosing IBR (45% implant reconstruction and 19% autologous). The rate of DBR was lower, 22% (11/50), following OP MDM compared to 35% (11/31) before OP MDM. Conclusion There has been an increased uptake of breast reconstruction surgery from 28% to 42%. The biggest impact was on those opting for the immediate type reconstruction option (78%). The OP MDM has significantly contributed to this increased rate of reconstruction.
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Affiliation(s)
- Mohsen M El Gammal
- Department of Breast Surgery, Parapet Breast Centre, Frimley Health Foundation Trust, Windsor
| | - Maria Lim
- Department of Breast Surgery, Parapet Breast Centre, Frimley Health Foundation Trust, Windsor
| | - Rajan Uppal
- Department of Plastic and Reconstructive Surgery, Wexham and Heatherwood Hospital, Frimley Health Foundation Trust, Slough, UK
| | - Richard Sainsbury
- Department of Breast Surgery, Parapet Breast Centre, Frimley Health Foundation Trust, Windsor
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Kamali P, Curiel D, van Veldhuisen CL, Bucknor AEM, Lee BT, Rakhorst HA, Lin SJ. Trends in immediate breast reconstruction and early complication rates among older women: A big data analysis. J Surg Oncol 2017; 115:870-877. [PMID: 28409847 DOI: 10.1002/jso.24595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/08/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although approximately 57% of breast cancer (BC) diagnoses are in older patients (>60 years), only 4.1-14% receives breast reconstruction (BR). This has been attributed to physician concerns about operative complications. This paper aims to: 1) analyze the 30-day complication rates in the older patient population undergoing immediate breast reconstruction (IBR); and 2) analyze links between complication type and category of reconstruction. METHODS Using the ACS-NSQIP database (2005-2014), all women older than 60 years of age diagnosed with BC and DCIS were identified. IBR and complication rates were plotted for all ages. Patients were divided into those with and those without complications. Patient demographics and co-morbidities were compared. Complications within each type of reconstruction were analyzed. RESULTS Of the 4450 BC and 1104 DCIS patients, 22.3% (BC) and 20.9% (DCIS) had complications. IBR decreased significantly with increased age (P < 0.00 in both cohorts), while complication rates remained stable across all ages (P = 0.32 in BC, P = 0.69 in DCIS patients). Patients were well matched in terms of demographics. CONCLUSIONS The rates of breast reconstruction decrease with increasing age. Despite increasing age, associated complication rates in IBR patients remained stable.
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Affiliation(s)
- Parisa Kamali
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel Curiel
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Charlotte L van Veldhuisen
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexandra E M Bucknor
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Hinne A Rakhorst
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Division of Plastic- Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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