Breast reconstruction outcomes analysis
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Breast Reconstruction: Outcomes Analysis. Michael J Bass, MD, JD www.drmichaeljbass.com Michael J Bass Plastic Surgery, PLLC. Disclosures. None Still need some. Analysis Factors. What affects outcome Neoadjuvant chemotherapy (Malata) Radiation (Cordeiro) Overall Satisfaction

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Breast Reconstruction: Outcomes Analysis

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Breast reconstruction outcomes analysis

Breast Reconstruction: Outcomes Analysis

Michael J Bass, MD, JD

www.drmichaeljbass.com

Michael J Bass Plastic Surgery, PLLC


Disclosures

Disclosures

  • None

  • Still need some


Analysis factors

Analysis Factors

  • What affects outcome

    • Neoadjuvant chemotherapy (Malata)

    • Radiation (Cordeiro)

  • Overall Satisfaction

    • Unilateral versus bilateral reconstruction (Craft)


Neoadjuvant chemotherapy and immediate breast reconstruction

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

Neoadjuvant Chemo (cont.)

Malata, et al, Plastic and Reconstructive Surgery July 2010;126(1):1-11


Neoadjuvant chemo cont1

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

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

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 cont1

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 cont2

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

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

Unilateral Versus Bilateral (cont.)

Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24


Unilateral versus bilateral cont1

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

Unilateral Versus Bilateral (cont.) Reconstruction (cont.)

Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24


Barriers to reconstruction

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


Thank you for coming

Thank You For Coming

  • Your participation in this lecture creates new opportunities for newly diagnosed women

  • Breast cancer is far away from being treated with a pill


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