The aim of this study is to assess the complication profile and impact on patient-reported quality of life in those undergoing nipple-sparing mastectomy (NSM) with immediate breast reconstruction and subsequent prosthetic reconstruction in patients with prior breast radiation therapy (pRT) vs those receiving adjuvant post-mastectomy radiation therapy (PMRT). An IRB-approved, retrospective analysis was performed from 2002 to 2014 to identify NSM patients that underwent pRT or PMRT. A 22-item Likert scale questionnaire was administered by a third party to register patient-reported quality of life. Forty patients met criteria for outcomes analysis, and 30 patients answered the questionnaire. Mean age was 45.6 years old and mean follow-up was 3.8 years. Complication rates for the PMRT cohort were 61.9% vs 31.6% in the pRT cohort, P = .067, and those requiring operative intervention were PMRT 38.1% vs pRT 5.3%, P = .021. Nipple-areolar complex survival was 100% in the pRT vs 85.7% in the PMRT, P = .233. Breast-related quality of life scores were superior in the pRT group within multiple domains. Patients are more likely to develop complications requiring an operative intervention and have decreased breast-related quality of life when undergoing NSM with PMRT compared to patients undergoing NSM having received pRT.
Too often when it comes to medical care or inclusion in clinical research, pregnant women are treated differently and in effect penalized for being pregnant. Long ago, as a medical student, I learned that an absolute indication for cholecystectomy was gallstone pancreatitis. Yet, over the years (and recently), I have cared for pregnant patients with gallstone pancreatitis, some of them quite ill and some with recurrent disease, whom consulting surgeons declined to operate on specifically because of their pregnancy. Diagnostic imaging is sometimes foregone or modified unnecessarily because of pregnancy, and optimal medical therapies for various disorders, for example, autoimmune diseases, are not used out of theoretical concerns for fetal harm. The coronavirus disease 2019 (COVID-19) vaccine trials are but the most recent examples of why it is almost always a bad idea to make pregnancy an exclusion criterion in clinical trials of relevance to pregnant women. The upshot of that exclusion is that pregnant women who elect to receive COVID-19 vaccines do so without the knowledge they deserve to make an informed decision. In perhaps another example of pregnancy penalizing, in this month's issue of the journal (see page 855), Forbes et al 1 raise the possibility that, at least in the emergency department, pregnant women (and to a much smaller degree, nonpregnant, reproductive aged women) may be less likely to receive naloxone than reproductive-aged men when it is indicated for opioid-related overdose. Though multiple factors other than pregnancy might account for this differential treatment, their study makes one wonder whether opioid overdose therapy is another medical realm where the insidious problem of inappropriate pregnancy-modified care is operative.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.