Breast Reconstruction: Outcomes Analysis Michael J Bass, MD, JD Michael J Bass Plastic Surgery,...
-
Upload
samantha-edwards -
Category
Documents
-
view
214 -
download
0
Transcript of Breast Reconstruction: Outcomes Analysis Michael J Bass, MD, JD Michael J Bass Plastic Surgery,...
Breast Reconstruction: Outcomes Analysis
Michael J Bass, MD, JDwww.drmichaeljbass.com
Michael J Bass Plastic Surgery, PLLC
Analysis Factors
• What affects outcome– Neoadjuvant chemotherapy (Malata)– Radiation (Cordeiro)
• Overall Satisfaction– Unilateral versus bilateral reconstruction (Craft)
Neoadjuvant Chemotherapy and Immediate Breast Reconstruction
• 171 patients (198 breasts) by one surgeon– 64 free flaps, 74 pedicled
flaps, 60 implant based
• 53 neoadjuvant, 118 controls
• Neoadjuvant phase III randomized trial
Malata, et al, Plastic and Reconstructive Surgery July 2010;126(1):1-11
Neoadjuvant Chemo (cont.)
• Minor complications:– 6 (10%) neoadjuvant, 9 (6%) controls (p=.380)
• Major complications: – 1 (2%) neoadjuvant; 3 (2%) controls (p=1.0)
• No effect of neoadjuvant chemotherapy on risk of complications nor delay in adjuvant radiation
• Paper did not evaluate patient or surgeon satisfaction of reconstruction
Malata, et al, Plastic and Reconstructive Surgery July 2010;126(1):1-11
Radiation and Implant Based Reconstruction
• 143 patients with 1 year of follow up receiving immediate tissue expander reconstruction (1995-2001); no autologous reconstruction patients
• 68 patients with chest wall radiation (CWR) four weeks after placement of permanent prosthesis
• 75 control patients during same period
Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81
Radiation and Implants (cont.)
• Patients received 50 Gray in 25-28 fractions
• 6 MV to reconstructed breast, axillary apex, and supraclavicular region
• 68% of irradiated patients had grade II-IV capsular contracture; 40% control group (p=.006)
Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81
Radiation and Implants (cont.)
• Doctors: 80% of irradiated patients marked good-excellent; 88% for non-irradiated patients
• Patient satisfaction based upon self assessment questionnaire
• 67% irradiated, 88% non-irradiated patients satisfied (p=.004)
Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81
Radiation and Implants (cont.)
• No discussion on tumor grade or disease stage• 72% of irradiated patients and 85% of non-
irradiated patients would have again elected for tissue expander based reconstruction
Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81
Unilateral Versus Bilateral Reconstruction and Satisfaction
• 702 women (910 reconstructions) identified between 1999-2006
• 494 unilateral reconstructions, 416 bilateral reconstructions
Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24
Unilateral Versus Bilateral (cont.)
Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24
Unilateral Versus Bilateral (cont.)
• Patient surveys mailed• Minimum post reconstruction time 13
months, average of 56 months for unilateral and 49 months for bilateral patients
• Survey response: 75% unilateral, 79% bilateral
Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24
Unilateral Versus Bilateral (cont.) Reconstruction (cont.)
Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24
Barriers To Reconstruction
• Doctor recommendation to seek counseling with a plastic surgeon– 7/10 women eligible for reconstruction after a mastectomy are
not informed that the option exists (ASPS poll, 2009)• Logistical problem of coordinating consultations and
immediate reconstruction• Immediate reconstruction: 23.4% for invasive breast
cancer, 36.4% for DCIS• Medicaid kerfuffle quadrification in Kentucky• Age >50, rural living, black least likely to get
reconstruction