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Schmidt MK, Kelly JE, Brédart A, Cameron DA, de Boniface J, Easton DF, Offersen BV, Poulakaki F, Rubio IT, Sardanelli F, Schmutzler R, Spanic T, Weigelt B, Rutgers EJT. EBCC-13 manifesto: Balancing pros and cons for contralateral prophylactic mastectomy. Eur J Cancer 2023; 181:79-91. [PMID: 36641897 PMCID: PMC10326619 DOI: 10.1016/j.ejca.2022.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
After a diagnosis of unilateral breast cancer, increasing numbers of patients are requesting contralateral prophylactic mastectomy (CPM), the surgical removal of the healthy breast after diagnosis of unilateral breast cancer. It is important for the community of breast cancer specialists to provide meaningful guidance to women considering CPM. This manifesto discusses the issues and challenges of CPM and provides recommendations to improve oncological, surgical, physical and psychological outcomes for women presenting with unilateral breast cancer: (1) Communicate best available risks in manageable timeframes to prioritise actions; better risk stratification and implementation of risk-assessment tools combining family history, genetic and genomic information, and treatment and prognosis of the first breast cancer are required; (2) Reserve CPM for specific situations; in women not at high risk of contralateral breast cancer (CBC), ipsilateral breast-conserving surgery is the recommended option; (3) Encourage patients at low or intermediate risk of CBC to delay decisions on CPM until treatment for the primary cancer is complete, to focus on treating the existing disease first; (4) Provide patients with personalised information about the risk:benefit balance of CPM in manageable timeframes; (5) Ensure patients have an informed understanding of the competing risks for CBC and that there is a realistic plan for the patient; (6) Ensure patients understand the short- and long-term physical effects of CPM; (7) In patients considering CPM, offer psychological and surgical counselling before surgery; anxiety alone is not an indication for CPM; (8) Eliminate inequality between countries in reimbursement strategies; CPM should be reimbursed if it is considered a reasonable option resulting from multidisciplinary tumour board assessment; (9) Treat breast cancer patients at specialist breast units providing the entire patient-centred pathway.
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Affiliation(s)
- Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Anne Brédart
- Institut Curie, Paris, France; Psychology Institute, Psychopathology and Health Process Laboratory UR4057, Paris City University, Paris, France
| | - David A Cameron
- Edinburgh University Cancer Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Breast Unit, Capio St. Göran's Hospital, Stockholm, Sweden
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital - Aarhus University, Aarhus N, Denmark
| | - Fiorita Poulakaki
- Breast Surgery Department, Athens Medical Center, Athens, Greece; Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
| | - Tanja Spanic
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy; Europa Donna Slovenia, Ljubljana, Slovenia
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emiel J T Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Liu S, Chen S, Yang Y, Guan W. The effect and prognosis of combinative implantation by autologous-fat granule and prosthesis for breast reconstruction after radical mastectomy. Am J Transl Res 2021; 13:5256-5263. [PMID: 34150116 PMCID: PMC8205830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES In this study, we analyzed the effect and prognosis of combinative implantation of autologous-fat granule and prosthesis for breast reconstruction after radical mastectomy. METHODS 73 cases of breast cancer patients hospitalized from March 2015 to March 2017 were chosen and separated into observation group (n=41) and control group (n=32) on the basis of the surgical methods. Both the two groups underwent modified radical mastectomy. In addition, the control group received prosthesis implantation for breast reconstruction, and the observation group was implanted with combination of prosthesis and autologous-fat granule transplantation. Thereafter, the surgical indexes, postoperative complications, aesthetic effects of breast reconstruction and prognosis of the two groups of patients were evaluated. RESULTS The surgical duration of the observation group was obviously longer than that of the control group (P<0.05), while the two groups had insignificant difference in postoperative drainage duration and postoperative hospital stay (P>0.05). FACT-B score of both groups of patients one year after surgery was dramatically higher than that before surgery (P<0.05), and patients in observation group had remarkably higher scores than those in control group (P<0.05). The incidence of postoperative complications in observation group was substantially lower than that in control group (P<0.05). In addition, the aesthetic evaluation of the observation-group patients postoperatively was notably higher than that in control group (P<0.05), and there was no statistically significant difference in progression-free survival between the two groups (P>0.05). CONCLUSION The combinative implantation of both prosthesis and autologous-fat granule for breast reconstruction after radical mastectomy is simple in operation procedure, and has better aesthetic outcome and safety. It satisfies the aesthetic demand of patients while having lesions resection, and does not affect the surgical effect of modified radical mastectomy, which is worthy of clinical promotion.
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Affiliation(s)
- Shensong Liu
- Department of Plastic Surgery, Hainan Ruihan Medical Cosmetology HospitalHaikou 570204, Hainan, China
| | - Shaoshan Chen
- Department of Stomatology, Affiliated Kaikou Hospital of Xiangya Medical College, Central South UniversityHaikou 570204, Hainan, China
| | - Yongcheng Yang
- Department of Plastic Surgery, Hainan Ruihan Medical Cosmetology HospitalHaikou 570204, Hainan, China
| | - Weiwei Guan
- Department of Stomatology, Affiliated Kaikou Hospital of Xiangya Medical College, Central South UniversityHaikou 570204, Hainan, China
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Giunta RE, Hansson E, Andresen C, Athanasopoulos E, Benedetto GD, Celebic AB, Caulfield R, Costa H, Demirdöver C, Georgescu A, Hemelryck TV, Henley M, Kappos EA, Karabeg R, Karhunen-Enckell U, Korvald C, Mortillet SD, Murray DJ, Palenčár D, Piatkowski A, Pompeo FSD, Psaras G, Rakhorst H, Rogelj K, Rosenkrantz Hölmich L, Schaefer DJ, Spendel S, Stepic N, Vandevoort M, Vasar O, Waters R, Zic R, Moellhoff N, Elander A. ESPRAS Survey on Breast Reconstruction in Europe. HANDCHIR MIKROCHIR P 2021; 53:340-348. [PMID: 33784792 DOI: 10.1055/a-1424-1428] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) previously identified the need for harmonisation of breast reconstruction standards in Europe, in order to strengthen the role of plastic surgeons. This study aims to survey the status, current trends and potential regional differences in the practice of breast reconstruction in Europe, with emphasis on equity and access. MATERIALS AND METHODS A largescale web-based questionnaire was sent to consultant plastic and reconstructive surgeons, who are experienced in breast reconstruction and with understanding of the national situation in their country. Suitable participants were identified via the Executive Committee (ExCo) of ESPRAS and national delegates of ESPRAS. The results were evaluated and related to evidence-based literature. RESULTS A total of 33 participants from 29 European countries participated in this study. Overall, the incidence of breast reconstruction was reported to be relatively low across Europe, comparable to other large geographic regions, such as North America. Equity of provision and access to breast reconstruction was distributed evenly within Europe, with geographic regions potentially affecting the type of reconstruction offered. Standard practices with regard to radiotherapy differed between countries and a clear demand for European guidelines on breast reconstruction was reported. CONCLUSION This study identified distinct lack of consistency in international practice patterns across European countries and a strong demand for consistent European guidance. Large-scale and multi-centre European clinical trials are required to further elucidate the presented areas of interest and to define European standard operating procedures.
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Affiliation(s)
- Riccardo E Giunta
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
| | - Carolina Andresen
- Plastic Reconstructive Craniomaxillofacial Hand and Microsurgical Unit, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Elias Athanasopoulos
- Dept. of Plastic Surgery, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Giovanni di Benedetto
- Department of Plastic and Reconstructive Surgery, Marche Polytechnic University, Ancona, Italy
| | | | - Robert Caulfield
- Department of Plastic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Horacio Costa
- Aveiro University, Plastic Reconstructive Craniomaxilofacial Hand and Microsurgical Unit, Gaia Hospital Center
| | - Cenk Demirdöver
- Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Dokuz Eylul University,Izmir, Turkey
| | - Alexandru Georgescu
- University of Medicine Iuliu Hatieganu, Clinic of Plastic Surgery, Cluj-Napoca, Romania
| | | | - Mark Henley
- Department of Plastic and Reconstructive Surgery, Nottingham University Hospitals, United Kingdom
| | - Elisabeth A Kappos
- Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Reuf Karabeg
- Surgical Clinic "Karabeg", Sarajevo, Bosnia and Herzegovina
| | - Ulla Karhunen-Enckell
- Head of Breast Surgery Unit, Department of Surgery, Tampere University Hospital, Finland
| | - Christian Korvald
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Stephane de Mortillet
- Chirurgie Plastique, Reconstructrice et Esthétique, Pôle santé Léonard de Vinci, Chambray les Tours cedex, France
| | - Dylan J Murray
- National Paediatric Craniofacial Center, Children's Hospital Ireland, Temple Street, Dublin, Ireland
| | - Drahomír Palenčár
- Department of Plastic Surgery, Medical Faculty of Comenius University Bratislava, Slovakia
| | | | - Fabio Santanelli di Pompeo
- Plastic Surgery Unit, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | | | - Hinne Rakhorst
- Plastic and reconstructive surgery, ZGT, Hengelo, The Netherlands
| | - Klemen Rogelj
- Department of Plastic Surgery and Burns, University Medical Centre Ljubljana, Slovenia
| | | | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Stephan Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Nenad Stepic
- Clinic for Plastic Surgery and Burns Military Medical Academy, Belgrade, Serbia
| | | | - Olavi Vasar
- Hospital of Reconstructive Surgery, Tallinn, Estonia
| | - Ruth Waters
- Department of Burns & Plastic Surgery, Queen Elizabeth Hospital Birmingham, United Kingdom
| | - Rado Zic
- University Hospital Dubrava, Department of Plastic Reconstructive and Aesthetic Surgery, School of Medicine, University of Zagreb
| | - Nicholas Moellhoff
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
| | - Anna Elander
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
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Heidekrueger PI, Moellhoff N, Horch RE, Lohmeyer JA, Marx M, Heitmann C, Fansa H, Geenen M, Gabka CJ, Handstein S, Prantl L, von Fritschen U. Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany-A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions. J Clin Med 2021; 10:jcm10051016. [PMID: 33801419 PMCID: PMC7958631 DOI: 10.3390/jcm10051016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/20/2022] Open
Abstract
While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Demographics, patient characteristics, perioperative details and postoperative outcomes were accounted for. Centers performing < Ø 40 (low-volume (LV)) vs. ≥ Ø 40 (high-volume (HV)) annual DIEP flaps were analyzed separately. Overall, total and partial flap loss rates were as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery was performed in 4.3% of cases. Revision surgery due to wound complications was conducted in 8.3% of all cases. Mean operative time and length of hospital stay was significantly shorter in the HV group (LV: 385.82 min vs. HV: 287.14 min; LV: 9.04 (18.87) days vs. HV: 8.21 (5.04) days; both p < 0.05). The outcome and complication rates deduced from the national registry underline the high standard of microsurgical breast reconstruction on a national level in Germany.
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Affiliation(s)
- Paul I. Heidekrueger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, 93053 Regensburg, Germany
- Correspondence: (P.I.H.); (L.P.); (U.v.F.); Tel.: +49-941-944-6763 (L.P.)
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, 80336 Munich, Germany;
| | - Raymund E. Horch
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, 91054 Erlangen, Germany;
| | - Jörn A. Lohmeyer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Agaplesion Diakonieklinikum Hamburg, 20259 Hamburg, Germany;
| | - Mario Marx
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, 01445 Radebeul, Germany;
| | | | - Hisham Fansa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Breast Centre Spital Zollikerberg, 8125 Zollikerberg, Switzerland;
| | - Matthias Geenen
- Department of Reconstructive Surgery, Lubinus Clinic Kiel, 24106 Kiel, Germany;
| | - Christian J. Gabka
- Nymphenburg Clinic for Plastic and Aesthetic Surgery, 80636 Munich, Germany;
| | - Steffen Handstein
- Department of Plastic, Reconstructive, and Breast Surgery, Municipal Hospital Goerlitz, 02828 Görlitz, Germany;
| | - Lukas Prantl
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, 93053 Regensburg, Germany
- Correspondence: (P.I.H.); (L.P.); (U.v.F.); Tel.: +49-941-944-6763 (L.P.)
| | - Uwe von Fritschen
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, 14165 Berlin, Germany
- Correspondence: (P.I.H.); (L.P.); (U.v.F.); Tel.: +49-941-944-6763 (L.P.)
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Lim DW, Metcalfe KA, Narod SA. Bilateral Mastectomy in Women With Unilateral Breast Cancer: A Review. JAMA Surg 2021; 156:569-576. [PMID: 33566074 DOI: 10.1001/jamasurg.2020.6664] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Rates of bilateral mastectomy continue to increase in average-risk women with unilateral in situ and invasive breast cancer. Contralateral prophylactic mastectomy rates increased from 5% to 12% of all operations for breast cancer in the US from 2004 to 2012. Among women having mastectomy, rates of contralateral prophylactic mastectomy have increased from less than 2% in 1998 to 30% in 2012. Observations The increased use of breast magnetic resonance imaging and genetic testing has marginally increased the number of candidates for bilateral mastectomy. Most bilateral mastectomies are performed on women who are at no special risk for contralateral cancer. The true risk of contralateral breast cancer is not associated with the decision for contralateral prophylactic mastectomy; rather, the clinical factors associated with the probability of distant recurrence are associated with bilateral mastectomy. Several changes in society and health care delivery appear to act concurrently and synergistically. First, the anxiety engendered by a fear of cancer recurrence is focused on the contralateral cancer because this is most easily conceptualized and provides a ready target that can be acted upon. Second, the modern woman with breast cancer is supported by the surgeon and the social community of breast cancer survivors. Surgeons want to respect patient autonomy, despite guidelines discouraging bilateral mastectomy, and most women have their expenses covered by a third-party payer. Satisfaction with the results is high, but the association with improved psychosocial well-being remains to be fully understood. Conclusions and Relevance Reducing the use of medically unnecessary contralateral prophylactic mastectomy in women with nonhereditary, unilateral breast cancer requires a social change that addresses patient-, physician-, cultural-, and systems-level enabling factors. Such a transformation begins with educating clinicians and patients. The concerns of women who want preventive contralateral mastectomy must be explored, and women need to be informed of the anticipated benefits (or lack thereof) and risks. Areas requiring further study are considered.
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Affiliation(s)
- David W Lim
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Kelly A Metcalfe
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Santosa KB, Oliver JD, Momoh AO. Contralateral prophylactic mastectomy and implications for breast reconstruction. Gland Surg 2021; 10:498-506. [PMID: 33634008 DOI: 10.21037/gs.2020.03.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Contralateral prophylactic mastectomy (CPM) rates have continued to rise in the United States, impacting all stakeholders including plastic and reconstructive surgeons. Multiple factors may be influencing this trend, including patient decision-making characteristics, knowledge about breast cancer disease and prognosis, advances in genetic testing and enhanced imaging capabilities, sociodemographic factors, and access to specialty surgical services such as breast reconstruction. In this review, the authors shed light on the current state of CPM and summarize the literature analyzing its increasing prevalence in the United States, as well as outline future directions for study and dissemination of knowledge from providers to patients surrounding this important and complex treatment decision.
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Affiliation(s)
- Katherine B Santosa
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jeremie D Oliver
- Department of Biomedical Engineering, School of Dentistry, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Adeyiza O Momoh
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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7
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Miseré R, Schop S, Heuts E, de Grzymala AP, van der Hulst R. Psychosocial well-being at time of diagnosis of breast cancer affects the decision whether or not to undergo breast reconstruction. Eur J Surg Oncol 2020; 46:1441-1445. [PMID: 32220543 DOI: 10.1016/j.ejso.2020.02.025] [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: 12/20/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Numerous studies have shown that breast reconstruction after mastectomy improves QoL in breast cancer survivors. However, still about half of the patients does not opt for reconstruction. In order to accommodate suitable counseling, we should elucidate the factors that play a role in the decision-making process. This study aimed to evaluate the influence of QoL, among women diagnosed with breast cancer before the start of any treatment, on their decision whether or not to undergo breast reconstruction. MATERIALS AND METHODS BREAST-Q surveys were provided to breast cancer patients at the specialized breast care outpatient clinic after their first consultation with a surgical oncologist, between June 2017 and March 2019. The Q-scores of the subdomains physical well-being, psychosocial well-being, sexual well-being, and satisfaction with breasts of patients that underwent mastectomy were statistically analyzed. RESULTS Sixty-seven patients, undergoing mastectomy, completed the questionnaire. Fifty-four percent received reconstructive surgery. Mean age of patients seeking breast reconstruction was significantly lower than patients who did not opt for a reconstruction (53.5 vs. 63.7). Mean follow-up after mastectomy was 18.1 months. Except for satisfaction with breasts, mean Q-scores were higher in the group of patients who did not choose for reconstructive surgery. Psychosocial well-being was significantly higher in the non-reconstruction group (p = 0.012). CONCLUSIONS Psychosocial well-being at time of diagnosis of breast cancer was significantly higher in patients refraining from breast reconstructive surgery after mastectomy. Psychosocial characteristics might be essential for the decision-making process as well. Further prospective research should evaluate this.
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Affiliation(s)
- Renée Miseré
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Sander Schop
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Esther Heuts
- Department of General Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Andrzej Piatkowski de Grzymala
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - René van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
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Putting Together the Pieces: Development and Validation of a Risk-Assessment Model for Nipple-Sparing Mastectomy. Plast Reconstr Surg 2020; 145:273e-283e. [PMID: 31985614 DOI: 10.1097/prs.0000000000006443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Freitas-Junior R, Ferreira-Filho DL, Soares LR, Paulinelli RR. Oncoplastic Breast-Conserving Surgery in Low- and Middle-Income Countries: Training Surgeons and Bridging the Gap. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00317-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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