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Breast Reconstruction: Outcomes Analysis

This comprehensive analysis evaluates the outcomes of breast reconstruction, focusing on variables such as neoadjuvant chemotherapy, radiation, and the differentiation between unilateral and bilateral procedures. Key findings include patient satisfaction rates post-reconstruction, complication rates, and the impact of pre-operative treatments. With data derived from multiple studies involving 171 patients and various reconstruction techniques, this analysis highlights significant disparities in satisfaction based on treatment types and underscores the urgent need for increased awareness about reconstruction options for patients post-mastectomy.

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Breast Reconstruction: Outcomes Analysis

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  1. Breast Reconstruction: Outcomes Analysis Michael J Bass, MD, JD www.drmichaeljbass.com Michael J Bass Plastic Surgery, PLLC

  2. Disclosures • None • Still need some

  3. Analysis Factors • What affects outcome • Neoadjuvant chemotherapy (Malata) • Radiation (Cordeiro) • Overall Satisfaction • Unilateral versus bilateral reconstruction (Craft)

  4. 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

  5. Neoadjuvant Chemo (cont.) Malata, et al, Plastic and Reconstructive Surgery July 2010;126(1):1-11

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. Unilateral Versus Bilateral (cont.) Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24

  13. 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

  14. Unilateral Versus Bilateral (cont.) Reconstruction (cont.) Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24

  15. 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

  16. 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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