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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

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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