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Arora N, Patel R, Sohi G, Merchant S, Martou G. A Scoping Review of the Application of BREAST-Q in Surgical Research. JPRAS Open 2023; 37:9-23. [PMID: 37288429 PMCID: PMC10242639 DOI: 10.1016/j.jpra.2023.04.005] [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: 04/09/2023] [Accepted: 04/30/2023] [Indexed: 06/09/2023] Open
Abstract
Background Collection of patient-reported outcome (PRO) data can facilitate cost-effective, evidence-based, and patient-centered care. The BREAST-Q has become the gold standard tool to measure PRO data in breast surgery. The last review of its application indicated that it was underutilized. Considering the evolution in breast surgery, the purpose of this study was to perform a scoping review of BREAST-Q application since 2015 and identify emerging trends and potential persistent gaps to guide patient-centered practice and future research in breast surgery. Methods We performed an electronic literature review to identify publications published in English that used the BREAST-Q to assess patient outcomes. We excluded validation studies, review papers, conference abstracts, discussions, comments, and/or responses to previously published papers. Results We identified 270 studies that met our inclusion criteria. Specific data was extracted to examine the evolution of the BREAST-Q application and examine clinical trends and research gaps. Discussion Despite a significant increase in BREAST-Q studies, gaps in the understanding of the patient experience remain. The BREAST-Q is uniquely designed to measure quality of life and satisfaction with outcome and care. The prospective collection of center-specific data for every type of breast surgery will generate important information for the provision of patient-centered and evidence-based care.
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Affiliation(s)
- Nikita Arora
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Ruchit Patel
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Gursharan Sohi
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Shaila Merchant
- Division of General Surgery and Surgical Oncology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Glykeria Martou
- Division of Plastic Surgery and Surgical Oncology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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Danko D, Ash ME, Brown OH, Losken A, Thompson PW. Implant-Based Breast Reconstruction in the Elderly: Complications and Patient-Reported Outcomes in Women Older Than 70 Years. Ann Plast Surg 2023; 91:55-61. [PMID: 37450861 DOI: 10.1097/sap.0000000000003615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Advanced age is considered by many to be a relative contraindication to breast reconstruction. However, despite increased medical comorbidities and a perception that elderly patients are less concerned with body image, more women older than 70 years are choosing to undergo breast reconstruction. There is a paucity of data to guide reconstructive decision-making and counseling in this population. OBJECTIVES The aim of this study was to evaluate patient satisfaction, complication rates, and long-term outcomes in women older than 70 years undergoing implant-based breast reconstruction. METHODS A total of 400 patients were identified at the authors' institution and divided into 2 groups: ≥70 and <70 years old. Medical comorbidities, surgical outcomes, and patient-reported outcomes as defined by the BREAST-Q were compared using the χ2 tests for categorical variables and t tests for continuous variables. RESULTS The cohort of patients older than 70 years was made up of 25 women, with a mean age of 73 years, and the cohort of patients younger than 70 years was made up of 375 women, with a mean age of 50 years. There was no significant difference in body mass index (P = 0.373), smoking status (P = 0.360), or history of prior ipsilateral radiation (P = 0.508) between the 2 cohorts; however, the elderly cohort was significantly more likely to have diabetes (P = 0.026). Although elderly patients were less likely to undergo bilateral mastectomy (P < 0.001), there was no significant difference in the type of mastectomy, pathological diagnosis, or method of reconstruction. There was no significant difference in complication rates when looking at minor infection (P = 0.553) or major infection (P = 0.553). The 2 groups were equally likely to undergo secondary procedures (P = 0.192). Overall satisfaction rates were high in all BREAST-Q categories in the elderly group and not significantly different when compared with the group of patients younger than 70 years. Matched-pair analysis showed a significant difference with the group of patients older than 70 years having higher levels physical well-being (P < 0.001). CONCLUSIONS Immediate breast reconstruction can be performed safely and with similar high satisfaction rates in the elderly population as their younger counterparts. Age alone should not be used as a reason for excluding women from these life-changing operations.
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Affiliation(s)
| | | | - Owen H Brown
- Department of Plastic and Reconstructive Surgery, Emory University, Atlanta, GA
| | - Albert Losken
- Department of Plastic and Reconstructive Surgery, Emory University, Atlanta, GA
| | - Peter W Thompson
- Department of Plastic and Reconstructive Surgery, Emory University, Atlanta, GA
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3
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Wang Y, Li G, Yang K, Bi Y, Liu Y, Mu D, Liu C, Xin M, Liu Y, Mu L. Analysis of Patient-Reported Outcomes After Breast Reconstruction: A Retrospective Study. Ann Plast Surg 2023; 90:S120-S124. [PMID: 36752395 DOI: 10.1097/sap.0000000000003373] [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: 02/09/2023]
Abstract
OBJECTIVE This study aimed to investigate the effects of surgical timing, procedure, and age, on complication rates, health-related quality of life, and postoperative satisfaction, in patients who underwent breast reconstruction. METHODS The data of 80 patients who underwent breast reconstruction surgery between August 2004 and June 2018 were reviewed. Patients were grouped according to surgical timing, procedure, and age. The evaluation indicators included complications and BREAST-Q scores. The statistical methods used included the Mann-Whitney U test and analyses of variance and covariance. RESULTS The incidence of complications was 15.0% (12/80). The complication rates were similar in each group ( P > 0.05). The postsurgical scores of patient satisfaction with breast, psychosocial well-being, and sexual well-being were higher than the presurgical scores ( P < 0.05). The postoperative psychosocial and sexual well-being scores of patients in the immediate group were higher than those in the delayed group ( P < 0.05). The satisfaction with the outcome in the abdominal flap group was higher than that in the other group, whereas the sexual well-being score of the abdominal flap group was lower than that of the other group ( P < 0.05). The scores of the postoperative physical well-being of the chest and abdomen in the younger group were higher than that in the older group ( P < 0.05). CONCLUSIONS Breast reconstruction can significantly improve patients' health-related quality of life and satisfaction. Immediate breast reconstruction can reduce the adverse psychological and physical effects that breast loss exerts on patients, leading to better postoperative satisfaction. Patients who underwent breast reconstruction with abdominal flaps had higher postoperative satisfaction. Breast reconstruction in elderly patients was associated with considerable postoperative satisfaction.
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Affiliation(s)
- Yi Wang
- From the Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Guangxue Li
- Peking University People's Hospital, Beijing, China
| | - Kai Yang
- Peking University People's Hospital, Beijing, China
| | - Ye Bi
- Peking University People's Hospital, Beijing, China
| | - Yan Liu
- Peking University People's Hospital, Beijing, China
| | - Dali Mu
- Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chunjun Liu
- Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Minqiang Xin
- Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuanbo Liu
- Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lan Mu
- The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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Quality of Life 9 to 13 Years after Autologous or Alloplastic Breast Reconstruction: Which Breast Remains Best? Plast Reconstr Surg 2023; 151:467-476. [PMID: 36730486 PMCID: PMC9944754 DOI: 10.1097/prs.0000000000009899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the long-term patient satisfaction and quality of life 9 to 13 years after autologous versus alloplastic breast reconstruction and compare the data to those of an earlier study. METHODS This is a 9-year follow-up study of 92 women who underwent breast reconstruction (47 autologous and 45 alloplastic) between 2006 and 2010 and filled out the BREAST-Q questionnaire in 2010. Changes in BREAST-Q scores were analyzed by using a change score from baseline (2010) to follow-up (2019), which was presented by a mean change score with 95% confidence intervals. Linear regression analyses were performed to test which patient characteristics were related to the BREAST-Q change scores. RESULTS The response rate at follow-up was 60% (25 autologous and 30 alloplastic). Responders at follow-up had a lower body mass index and had less frequently undergone unilateral breast reconstruction compared to the nonresponders. Women undergoing both autologous and alloplastic breast reconstruction had significantly decreased satisfaction with breasts (-4 points), satisfaction with outcome (-8 points), and satisfaction with nipples (-20 points) over time. None of the patient characteristics, including reconstruction technique, were related to the BREAST-Q change scores. CONCLUSIONS Satisfaction with breasts, satisfaction with outcome, and satisfaction with nipples decreased slightly over time for women undergoing alloplastic and autologous breast reconstruction. Women undergoing autologous breast reconstruction seemed to remain more satisfied with their breasts 9 to 13 years after breast reconstruction compared to women undergoing alloplastic breast reconstruction. Because of the small sample size, conclusions should be carefully drawn. However, the results were in line with the expectations based on previous literature.
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Gallo L, Chu JJ, Shamsunder MG, Hatchell A, Patel A, Godwin K, Hernandez M, Pusic AL, Nelson JA, Voineskos SH. Best Practices for BREAST-Q Research: A Systematic Review of Study Methodology. Plast Reconstr Surg 2022; 150:526e-535e. [PMID: 35749737 PMCID: PMC9805659 DOI: 10.1097/prs.0000000000009401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Data heterogeneity and methodologic errors hinder the ability to draw clinically meaningful conclusions from studies using the BREAST-Q Reconstruction Module patient-reported outcome measure. In this systematic review, the authors evaluate the quality of BREAST-Q Reconstruction Module administration in relation to the BREAST-Q version 2.0 user's guide and the reporting of key methodology characteristics. The authors also describe a framework for improving the quality of BREAST-Q data analysis and reporting. METHODS The authors conducted a systematic search of PubMed, Embase, Cochrane CENTRAL, and Ovid HAPI databases to identify articles on the BREAST-Q Reconstruction Module to assess postmastectomy breast reconstruction outcomes. The authors registered the protocol before study implementation on Open Science Framework ( https://osf.io/c5236 ) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data on mode of BREAST-Q administration, time horizon justification, and sample size calculation were collected. RESULTS The authors included 185 studies in the analysis. Errors in BREAST-Q administration were identified in 36 studies (19.5 percent). Appropriate administration of the BREAST-Q could not be determined in 63 studies (34.1 percent) because of insufficient reporting. Time horizon for the primary outcome was reported in 71 studies (38.4 percent), with only 17 (9.2 percent) reporting a sample size calculation. CONCLUSIONS The authors identified important yet actionable shortcomings in the BREAST-Q literature. Researchers are encouraged to review the BREAST-Q user's guide in the study design phase to mitigate errors in patient-reported outcome measure administration and reporting for future trials using the BREAST-Q Reconstruction Module. Adhering to these guidelines will allow for greater clinical utility and generalizability of BREAST-Q research.
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Affiliation(s)
- Lucas Gallo
- Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Jacqueline J. Chu
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghana G. Shamsunder
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Aadit Patel
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marisol Hernandez
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L. Pusic
- Division of Plastic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sophocles H. Voineskos
- Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
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Harrison CA, Parks RM, Cheung KL. The impact of breast cancer surgery on functional status in older women - A systematic review of the literature. Eur J Surg Oncol 2021; 47:1891-1899. [PMID: 33875285 DOI: 10.1016/j.ejso.2021.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022] Open
Abstract
Primary endocrine therapy as treatment of breast cancer is only recommended in older women with limited life expectancy. However, many older women opt for endocrine therapy due to concerns regarding frailty and potential decline in function after surgery. A decline in functional status after surgery is documented in some cancer types, such as colorectal, however, the full impact of breast cancer surgery is less understood. A systematic review was performed to examine the evidence for impact of breast cancer surgery on functional status in older women. PubMed and Embase databases were searched. Studies were eligible if performed within the last 10 years; included patients over the age of 65 years undergoing breast cancer surgery; included stratification of results by age; measured functional status pre-operatively and at least six months following surgery. A total of 11 studies including 12 030 women were appraised. Two studies represented level-II and nine level-IV evidence. Overall, physical activity level was negatively impacted by breast cancer surgery and this was compounded by the extent of surgery. Evidence for impact of breast cancer surgery on quality of life, fatigue and cognition, was conflicting. The possibility of decline in functional status after breast cancer surgery should be discussed in all older women considering surgery. A structured exercise program may improve the negative effects of surgery on physical activity. Further work is required in the areas of quality of life, fatigability and cognition.
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Affiliation(s)
- C A Harrison
- Nottingham Breast Cancer Research Centre, University of Nottingham, UK
| | - R M Parks
- Nottingham Breast Cancer Research Centre, University of Nottingham, UK
| | - K L Cheung
- Nottingham Breast Cancer Research Centre, University of Nottingham, UK.
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7
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Outcome of Quality of Life for Women Undergoing Autologous versus Alloplastic Breast Reconstruction following Mastectomy: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2020; 145:1109-1123. [DOI: 10.1097/prs.0000000000006720] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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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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9
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Roh DS, Panayi AC, Bhasin S, Orgill DP, Sinha I. Implications of Aging in Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2085. [PMID: 30859042 PMCID: PMC6382222 DOI: 10.1097/gox.0000000000002085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/26/2018] [Indexed: 12/12/2022]
Abstract
Given the rapidly aging population, investigating the effect of age on plastic surgery outcomes is imperative. Despite this, the topic has received relatively little attention. Furthermore, there appears to be little integration between the basic scientists investigating the mechanisms of aging and the plastic surgeons providing the majority of "antiaging" therapies. This review first provides a description of the effects and mechanisms of aging in 5 types of tissue: skin, adipose tissue, muscles, bones and tendons, and nervous tissue followed by an overview of the basic mechanisms underlying aging, presenting the currently proposed cellular and molecular theories. Finally, the impact of aging, as well as frailty, on plastic surgery outcomes is explored by focusing on 5 different topics: general wound healing and repair of cutaneous tissue, reconstruction of soft tissue, healing of bones and tendons, healing of peripheral nerves, and microsurgical reconstruction. We find mixed reports on the effect of aging or frailty on outcomes in plastic surgery, which we hypothesize to be due to exclusion of aged and frail patients from surgery as well as due to outcomes that reported no postsurgical issues with aged patients. As plastic surgeons continue to interact more with the growing elderly population, a better appreciation of the underlying mechanisms and outcomes related to aging and a clear distinction between chronological age and frailty can promote better selection of patients, offering appropriate patients surgery to improve an aged appearance, and declining interventions in inappropriate patients.
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Affiliation(s)
- Danny S Roh
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Adriana C Panayi
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Shalender Bhasin
- Division of Endocrinology, Brigham and Women's Hospital, Boston, Mass
| | - Dennis P Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Indranil Sinha
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
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10
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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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11
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Patel SA, Ng M, Nardello SM, Ruth K, Bleicher RJ. Immediate breast reconstruction for women having inflammatory breast cancer in the United States. Cancer Med 2018; 7:2887-2902. [PMID: 29761885 PMCID: PMC6051180 DOI: 10.1002/cam4.1546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/10/2018] [Accepted: 03/15/2018] [Indexed: 01/07/2023] Open
Abstract
Inflammatory breast cancer (IBC) is an aggressive malignancy having a poor prognosis. Traditionally, reconstruction is not offered due to concerns about treatment delay, margin positivity, recurrence, and poor long-term survival. There is a paucity of literature, however, evaluating whether immediate breast reconstruction (IBR) is associated with greater mortality in patients with IBC. A population-based study was conducted via the SEER-Medicare-linked database (1991-2009). Female patients greater than 65 years were reviewed who had mastectomy and reconstruction claims for nonmetastatic IBC. Competing risk and Cox regression were used to assess whether IBR was associated with higher breast cancer-specific mortality (BCSM) or overall mortality (OM). Among 552 936 patients, 1472 (median age 74 years) were diagnosed with IBC and had a mastectomy. Forty-four patients (3%) underwent IBR. Younger age, a lower Charlson comorbidity score, and a greater median income were predictors of IBR use. Tumor grade, hormone receptor status, and lymph node status were independent predictors of adjusted OM and BCSM. There was no difference by IBR status in BCSM or covariate-adjusted BCSM (sHR 1.04; CI 0.71-1.54; P = .83 and sHR 1.13; CI 0.84-1.93; P = .58, respectively). Cumulative incidence of OM was lower among IR patients (P = .013), and IR did not influence the cumulative incidence of BCSM (P = .91). IBR was not associated with increased overall and BCSM mortality. Although further study of IBR in the IBC setting may be of value, these data suggest that IBC should not be considered an absolute contraindication to IBR.
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Affiliation(s)
- Sameer A. Patel
- Department of Surgical OncologyFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Marilyn Ng
- Division Plastic, Reconstructive and Hand SurgeryDepartment of SurgeryNorthwell Health‐Staten Island University HospitalStaten IslandNYUSA
| | | | - Karen Ruth
- Department of BiostatisticsFox Chase Cancer CenterPhiladelphiaPAUSA
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Cereijo-Garea C, Pita-Fernández S, Acea-Nebril B, Rey-Villar R, García-Novoa A, Varela-Lamas C, Builes-Ramirez S, Seoane-Pillado T, Balboa-Barreiro V. Predictive factors of satisfaction and quality of life after immediate breast reconstruction using the BREAST-Q©. J Clin Nurs 2018; 27:1464-1474. [DOI: 10.1111/jocn.14291] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Carmen Cereijo-Garea
- Breast Unit; Complexo Hospitalario Universitario A Coruña (CHUAC); SERGAS; A Coruña Spain
| | - Salvador Pita-Fernández
- Clinical Epidemiology and Biostatistics Research Group; Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); SERGAS; Universidade da Coruña; A Coruña Spain
| | - Benigno Acea-Nebril
- Department of Surgery; Breast Unit; Complexo Hospitalario Universitario A Coruña (CHUAC); SERGAS; A Coruña Spain
| | - Raquel Rey-Villar
- Breast Unit; Complexo Hospitalario Universitario A Coruña (CHUAC); SERGAS; A Coruña Spain
| | - Alejandra García-Novoa
- Department of Surgery; Breast Unit; Complexo Hospitalario Universitario A Coruña (CHUAC); SERGAS; A Coruña Spain
| | - Cristina Varela-Lamas
- Department of Surgery; Breast Unit; Complexo Hospitalario Universitario A Coruña (CHUAC); SERGAS; A Coruña Spain
| | - Sergio Builes-Ramirez
- Department of Surgery; Breast Unit; Complexo Hospitalario Universitario A Coruña (CHUAC); SERGAS; A Coruña Spain
| | - Teresa Seoane-Pillado
- Clinical Epidemiology and Biostatistics Research Group; Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); SERGAS; Universidade da Coruña; A Coruña Spain
| | - Vanesa Balboa-Barreiro
- Clinical Epidemiology and Biostatistics Research Group; Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); SERGAS; Universidade da Coruña; A Coruña Spain
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13
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Role of Age, Tumor Grade, and Radiation Therapy on Immediate Postmastectomy Breast Reconstruction. Clin Breast Cancer 2017; 18:313-319. [PMID: 29305307 DOI: 10.1016/j.clbc.2017.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/23/2017] [Accepted: 11/29/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite the psychological benefits and oncologic safety of postmastectomy breast reconstruction, most breast cancer patients do not undergo reconstruction. To better understand the patterns of breast reconstruction usage, it is important to identify the clinicopathologic factors associated with immediate breast reconstruction (IBR), and whether modification of the reconstruction incidence when stratified by patient- or cancer-related factors exists in the breast cancer population. The primary objectives were to determine whether the incidence of immediate postmastectomy breast reconstruction varies across age, and whether the tumor grade or radiation therapy modify the effect of age on the incidence of immediate breast reconstruction. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results database, we identified women who had undergone mastectomy for breast cancer from 2000 to 2014. Inverse probability of treatment-weighted log-binomial regression was used to estimate the effect of age on IBR after accounting for potential confounding by patient demographic data and cancer characteristics. Potential effect measure modification by tumor grade and radiation therapy on the age-IBR relationship was also assessed. RESULTS Of 321,206 women, 77,798 (24.2%) had undergone IBR. Age was significantly associated with IBR prevalence (P < .0001), with younger women more likely to undergo IBR. Both tumor grade (P < .0001) and radiation therapy (P < .0001) modified the effect of age on IBR. CONCLUSION Compared with their older counterparts, younger breast cancer patients were more likely to undergo IBR, and both tumor grade and radiation therapy were differentially associated with the likelihood of IBR across patient age.
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14
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Chattha A, Bucknor A, Kamali P, Van Veldhuisen CL, Flecha-Hirsch R, Sharma R, Tobias AM, Lee BT, Lin SJ. Comparison of risk factors and complications in patients by stratified mastectomy weight: An institutional review of 1041 consecutive cases. J Surg Oncol 2017; 116:811-818. [DOI: 10.1002/jso.24753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/12/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Anmol Chattha
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Alexandra Bucknor
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Parisa Kamali
- 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
| | - Renata Flecha-Hirsch
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Ranjna Sharma
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Adam M. Tobias
- 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
| | - Samuel J. Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
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15
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Santosa KB, Qi J, Kim HM, Hamill JB, Pusic AL, Wilkins EG. Effect of Patient Age on Outcomes in Breast Reconstruction: Results from a Multicenter Prospective Study. J Am Coll Surg 2016; 223:745-754. [PMID: 27806906 DOI: 10.1016/j.jamcollsurg.2016.09.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although >40% of new breast cancer diagnoses in the US are in older women, few studies have assessed the outcomes of post-mastectomy reconstruction in this population. Our objective was to evaluate age effects on postoperative complications and patient-reported outcomes in women undergoing breast reconstruction, and to investigate whether age effects differ between reconstructive procedure types. STUDY DESIGN Eligible patients in the Mastectomy Reconstruction Outcomes Consortium study from 11 institutions (57 providers) in North America were analyzed. Two-year complications and patient-reported outcomes via BREAST-Q domains were compared across younger (younger than 45 years), middle-aged (45 to 60 years), and older (older than 60 years) women. Mixed-effects regression models were used, controlling for a range of demographic and clinical covariates. RESULTS A total of 1,531 patients were studied: 494 younger, 803 middle-aged, and 234 older. Age was not a significant predictor of complications. For sexual well-being 2 years post-reconstruction, older women reported 4.25 (p = 0.04) higher mean scores with implant procedures, and 10.39 (p < 0.01) higher mean scores with autologous procedures compared with younger women. No age effect was seen with implant procedures with regard to physical and psychosocial well-being; however, older women who underwent autologous procedures reported 6.07 (p < 0.01) higher physical, and 8.21 (p < 0.01) higher psychosocial well-being scores than younger women. CONCLUSIONS Age did not significantly affect complication rates. Older women demonstrated higher sexual well-being for both procedures, and better satisfaction and physical and psychosocial well-being than younger women with autologous procedures. Post-mastectomy reconstruction is a viable option for older patients, with risks and benefits comparable with those in younger women.
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Affiliation(s)
- Katherine B Santosa
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Ji Qi
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Hyungjin M Kim
- Center for Statistical Consultation and Research, Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Jennifer B Hamill
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Andrea L Pusic
- Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Edwin G Wilkins
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
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