1
|
Alghamdi H, Alhefdhi A, Fayi KA, Alshaalan SF, Alsuhaim AK, Almutairi RH, Alkilani N, Aolayan H, Awad MR. The Satisfaction and Quality of Life of Patients After Breast Reconstruction: A Cross-Sectional Multicenter Study Comparing Immediate, Delayed, and Nonreconstructive Outcomes. Ann Plast Surg 2024:00000637-990000000-00504. [PMID: 38984731 DOI: 10.1097/sap.0000000000004040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
BACKGROUND Breast reconstruction following mastectomy can be performed through various surgical techniques that prioritize the patient's safety and quality of life. Plastic surgeons are trained to choose the most appropriate surgical approach based on the individual patient's needs and medical history. The safety of the patient is always the primary concern, followed by considerations such as aesthetic outcomes and long-term health implications. OBJECTIVES The aim of this study was to assess and document patients' satisfaction and quality of life after breast reconstruction across Saudi Arabia. METHODS This is a cross-sectional multicenter study among female patients who underwent mastectomy with or without breast reconstruction between 2015 and 2022. Two hundred eighty patients participated in this study through a call-based Arabic version of the BREAST-Q questionnaire to analyze the quality of their lives and satisfaction. RESULTS Our results showed that patients who underwent delayed reconstruction had lower satisfaction than those who underwent immediate reconstruction. The average BREAST-Q score was lower in patients who used tissue expanders than those with implant-based reconstruction, autologous reconstruction, or combined approaches. Patients who underwent simple mastectomy had lower satisfaction (M = 66.1) than those who had a skin-sparing mastectomy (M = 71.1) and/or nipple-sparing mastectomy (M = 72.6). CONCLUSIONS This retrospective multicenter study observed a significant association between the time of the reconstructive surgery and patient's satisfaction; patients who underwent immediate reconstruction had higher satisfaction rate. Lower satisfaction rate was associated with tissue expander breast reconstruction. There is a significant association between satisfaction rate and smoking history.
Collapse
Affiliation(s)
- Hisham Alghamdi
- From the Division of Plastic Surgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Amal Alhefdhi
- Associated professor Breast and endocrine surgery consultant KFSH&RC, Alfaisal University, Riyadh, Saudi Arabia
| | - Khalid A Fayi
- Division of Plastic Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Rahaf H Almutairi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Najla Alkilani
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hayfa Aolayan
- Division of Breast and Endocrine Surgery, Department of Surgery, Qassim University, Qassim, Saudi Arabia
| | - Mohamed R Awad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Shah JK, Amakiri UO, Cevallos P, Yesantharao P, Ayyala H, Sheckter CC, Nazerali R. Updated Trends and Outcomes in Autologous Breast Reconstruction in the United States, 2016-2019. Ann Plast Surg 2024; 92:e1-e13. [PMID: 38320006 DOI: 10.1097/sap.0000000000003764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Autologous breast reconstruction (ABR) has increased in recent decades, although concerns for access remain. As such, our goal is to trend national demographics and operative characteristics of ABR in the United States. METHODS Using the National Inpatient Sample, 2016-2019, the International Classification of Disease , Tenth Edition codes identified adult female encounters undergoing ABR. Demographics and procedure-related characteristics were recorded. Discharge weights generated national estimates. Statistical analysis included univariate testing and multivariate regression modeling. RESULTS A total of 52,910 weighted encounters met the criteria (mean age, 51.5 ± 10.0 years). Autologous breast reconstruction utilization increased (Δ = +5%), 2016-2019, primarily driven by a rise in deep inferior epigastric perforator (DIEP) reconstructions (Δ = +28%; incidence rate ratio [IRR], 1.070; P < 0.001), which were predominant throughout the study period (69%). More recent surgery year, bilateral reconstruction, higher income levels, commercial insurance, and care in the South US region increased the odds of DIEP-based ABR ( P ≤ 0.036). Transverse rectus abdominis myocutaneous flaps, bilateral reconstructions, higher comorbidity levels, and experiencing complications increased the length of stay ( P ≤ 0.038). Most ABRs (75%) were privately insured. The rates of immediate reconstructions increased over the study period (from 26% to 46%; IRR, 1.223; P < 0.001), as did the rates of bilateral reconstructions (from 54% to 57%; IRR, 1.026; P = 0.030). The rates of ABRs performed at teaching hospitals remained high (90% to 93%; P = 0.242). CONCLUSIONS As of 2019, ABR has become more prevalent, with the DIEP flap constituting the most common modality. With the increasing ABR popularity, efforts should be made to ensure geographic and financial accessibility.
Collapse
Affiliation(s)
- Jennifer K Shah
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | | | | | - Pooja Yesantharao
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Haripriya Ayyala
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Clifford C Sheckter
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Rahim Nazerali
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
3
|
Lee SJ, Yang YJ, Lee DW, Song SY, Lew DH, Yang EJ. Influence of sarcopenia on postoperative complications in patients undergoing autologous microsurgical breast reconstruction: an inverse probability of treatment weighting analysis. Front Oncol 2023; 13:1211593. [PMID: 38023138 PMCID: PMC10652871 DOI: 10.3389/fonc.2023.1211593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Sarcopenia is characterized by the loss of skeletal muscle mass and power. Preoperative sarcopenia may be associated with an increased risk of postoperative complications after autologous free-flap breast reconstruction surgery; however, this relationship is controversial. Objectives This study aimed to determine whether preoperative sarcopenia is associated with a high complication rate in patients undergoing autologous free-flap breast reconstruction. Methods Patients who underwent autologous free-flap breast reconstruction at our hospital between 2019 and 2021 were included in the study. Data on significant complications requiring surgical intervention were retrospectively collected from the medical records. Sarcopenia was defined as having a skeletal muscle index value <41 cm2/m2. The skeletal muscle index was calculated by dividing the sum of the psoas and iliopsoas muscle areas at the level of the third lumbar vertebra by the patient's height in meters squared. The relationship between preoperative sarcopenia and postoperative complications was investigated using an inverse probability of treatment weighting (IPTW) analysis. Results Among the 203 participants, 90 (44.33%) had preoperative sarcopenia. The general patient characteristics were similar between the sarcopenia and non-sarcopenia groups after IPTW adjustment. Sarcopenia did not significantly increase the risk of flap failure or emergency surgery related to breast reconstruction before IPTW adjustment. However, after IPTW adjustment, the rates of recipient site infection and hematoma were significantly higher in participants with sarcopenia than in those without sarcopenia (p < 0.001 and p = 0.014, respectively). Conclusion Preoperative sarcopenia may influence certain complications of autologous free-flap breast reconstruction surgery.
Collapse
Affiliation(s)
- Seung-Jun Lee
- Department of Plastic and Reconstructive Surgery, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun-Jung Yang
- Department of Convergence Science, College of Medicine, Catholic Kwandong University International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Dong-Won Lee
- Department of Plastic and Reconstructive Surgery, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Yong Song
- Department of Plastic and Reconstructive Surgery, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae-Hyun Lew
- Department of Plastic and Reconstructive Surgery, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Jung Yang
- Department of Plastic and Reconstructive Surgery, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Abstract
The gold standard for autologous reconstruction in the post-mastectomy patient remains the deep inferior epigastric artery perforator flap, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap) and trunk (lumbar artery perforator flap, superior and inferior gluteal artery perforator flaps). This study will review the history, relevant anatomy, surgical technique and outcomes for alternative flaps in autologous reconstruction. Additionally, preoperative imaging (CTA, MRA) and novel applications (stacking flaps, neurotization) in breast reconstructive microsurgery will be discussed.
Collapse
Affiliation(s)
- Paige L Myers
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
5
|
Zhang JQ, Zhang JM, Liang WQ, Ji CY, Chen YH. Lengthening the pedicle of the rectus abdominis myocutaneous flap for repair of upper chest and neck defects. Ann R Coll Surg Engl 2017; 99:464-471. [PMID: 28660811 DOI: 10.1308/rcsann.2017.0055] [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: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate whether the pedicle of the rectus abdominis flap can be lengthened by resecting the inferior costal cartilage segments or associated muscle when repairing upper body defects. A formula was generated that calculates the expected increase in pedicle length. METHODS Thirty patients underwent computed tomography. The width and thickness of the third to seventh inferior costal cartilage segments as well as the width of the respective intercostal spaces were recorded. Four patients underwent reconstruction of an upper body defect with the relevant flap. RESULTS The expected mean increases in pedicle length were 4.07cm (standard deviation [SD]: 0.31cm) and 4.63cm (SD: 0.54cm) following resection of the left and right sides respectively of the seventh inferior costal cartilage segment, 7.99cm (SD: 0.49cm) and 10.82cm (SD: 0.23cm) following resection of the left and right sides respectively of the sixth and seventh inferior costal cartilage segments while resection of the fourth to seventh inferior costal cartilage segments would equate to increases of 17.48cm (SD: 0.62cm) and 22.05cm (SD: 0.21cm) for the left and right sides respectively. In four patients who required reconstruction, three flaps survived without problems but one flap developed partial necrosis. CONCLUSIONS Resecting inferior costal cartilage segments or associated muscle can lengthen the pedicle of the rectus abdominis flap for reconstruction of defects on the upper chest and neck.
Collapse
Affiliation(s)
- J Q Zhang
- Sun Yat-sen Memorial Hospital , Guangzhou , China
| | - J M Zhang
- Sun Yat-sen Memorial Hospital , Guangzhou , China
| | - W Q Liang
- Sun Yat-sen Memorial Hospital , Guangzhou , China
| | - C Y Ji
- Sun Yat-sen Memorial Hospital , Guangzhou , China
| | - Y H Chen
- Sun Yat-sen Memorial Hospital , Guangzhou , China
| |
Collapse
|
6
|
Lopez Penha TR, Voogd AC, Heuts EM, Ijsbrandy C, Hendrix NA, von Meyenfeldt MF, van der Hulst RR. Reduced Prevalence of Lymphedema in Patients with Reconstructive Breast Surgery. Breast J 2014; 20:671-3. [DOI: 10.1111/tbj.12342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tiara R. Lopez Penha
- Department of Plastic, Reconstructive and Hand Surgery; Maastricht University Medical Centre+; Maastricht The Netherlands
- Department of General Surgery; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - Adri C. Voogd
- Department of Epidemiology; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - Esther M. Heuts
- Department of General Surgery; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - Charlotte Ijsbrandy
- Department of Plastic, Reconstructive and Hand Surgery; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - Nicole A.M. Hendrix
- Department of Plastic, Reconstructive and Hand Surgery; Maastricht University Medical Centre+; Maastricht The Netherlands
| | | | - Rene R.W.J. van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery; Maastricht University Medical Centre+; Maastricht The Netherlands
| |
Collapse
|
7
|
Paul H, Prendergast TI, Nicholson B, White S, Frederick WA. Breast reconstruction: current and future options. BREAST CANCER-TARGETS AND THERAPY 2011; 3:93-9. [PMID: 24367179 DOI: 10.2147/bctt.s13418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
When initiated by the devastating diagnosis of cancer, post ablative breast restoration has at its core the goal of restoring anatomic normalcy. The concepts of body image, wholeness, and overall well-being have been introduced to explain the paramount psychological influence the breast has on both individuals and society as a whole. Hence, a growing subspecialty has been established to recreate or simulate the lost breast. At least one third of breast cancer victims consider breast reconstruction. Breast reconstruction post mastectomy may be offered at the time of mastectomy or delayed post mastectomy after adjuvant therapy. This may be utilizing autologous tissues or implants and each has risks and benefits, especially when considering adjuvant therapy. In addition, there has been a move away from a traditional mastectomy to less invasive, but still curative procedures, such as skin-sparing and nipple-sparing mastectomy. These procedures provide the breast envelope to facilitate reconstruction. This paper reviews the primary issues in breast reconstruction, as well as their psychologic, oncologic, and social impact.
Collapse
Affiliation(s)
- Henry Paul
- Departments of Plastic Surgery, Howard University Hospital, Washington, DC, USA
| | | | - Bryson Nicholson
- General Surgery, Howard University Hospital, Washington, DC, USA
| | - Shenita White
- General Surgery, Howard University Hospital, Washington, DC, USA
| | - Wayne Ai Frederick
- General Surgery, Howard University Hospital, Washington, DC, USA ; Cancer Center, Howard University, Washington, DC, USA
| |
Collapse
|
8
|
Avraham T, Daluvoy SV, Riedel ER, Cordeiro PG, Van Zee KJ, Mehrara BJ. Tissue expander breast reconstruction is not associated with an increased risk of lymphedema. Ann Surg Oncol 2010; 17:2926-32. [PMID: 20499284 DOI: 10.1245/s10434-010-1112-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent reports have demonstrated that lymphedema can occur after even minor pertubation of the axillary region such as sentinel lymph node biopsy (SLNB). The impact of breast reconstruction on the development of lymphedema, however, remains unknown. Therefore, the purpose of this study was to determine the impact of immediate tissue expander breast reconstruction on the risk of developing lymphedema. MATERIALS AND METHODS We identified patients who had undergone mastectomy with SLNB or SLNB and axillary lymph node dissection (ALND) with or without breast reconstruction using our prospectively maintained lymphedema and breast reconstruction databases. The development of lymphedema was evaluated prospectively using arm measurements and a validated questionnaire. Associations between variables were examined. Logistic regression was used to examine the association of reconstruction on prevalence of lymphedema while adjusting individually for BMI, age, and weight gain after surgery. RESULTS Characteristics of patients with or without reconstruction were similar except for age, BMI, and weight gain since surgery. Median follow-up was 5 years. Among patients treated with mastectomy with SLNB or SLNB/ALND, those undergoing reconstruction had a lower rate of measured lymphedema than those who did not (5% vs. 18%, P < .0004). The reconstructed group also had fewer patients with both measured and self-reported lymphedema (3% vs. 12%, P < .002). Differences in the rates of measured lymphedema between groups persisted following univariate logistical regression for differences in age, BMI, and weight gain. CONCLUSIONS Tissue expander breast reconstruction in patients undergoing SLNB or SLNB/ALND does not increase the risk of developing measured or perceived lymphedema.
Collapse
Affiliation(s)
- Tomer Avraham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | |
Collapse
|
9
|
Paredes H. Revisión de la literatura sobre reconstrucción mamaria. Medwave 2010. [DOI: 10.5867/medwave.2010.01.4355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|