Effects of Immediate Breast Reconstruction on Psychosocial Morbidity After Mastectomy

Dean, Christine; Chetty, U.; Forrest, A. P. M.

doi:10.1016/s0140-6736(83)91452-6

Cited by 371 publications

(165 citation statements)

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“…Numerous studies have confirmed the positive psychological effects of breast reconstruction. [15][16][17][18] However, to the best our knowledge, there are a paucity of data examining the interaction between specific treatment variables and patient satisfaction with reconstruction. Different authors have considered the impact of implant versus autogenous tissue techniques and of immediate versus delayed reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Patient satisfaction with postmastectomy breast reconstruction

McCarthy¹,

Klassen²,

Cano³

et al. 2010

Cancer

116

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BACKGROUND. At a time when the safety and effectiveness of breast implants remains under close scrutiny, it is important to provide reliable and valid evidence regarding patient outcomes. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life may be the most significant outcome variables when evaluating surgical success. The objective of the current study was to identify predictors of patient satisfaction with breast appearance, including implant type, in a large sample of women who underwent breast reconstruction surgery using implants. METHODS. A multicenter, cross-sectional study design was used. A total of 672 women who had completed postmastectomy, implant-based reconstruction at 1 of 3 centers in North America were asked to complete the BREAST-Q (Reconstruction Module). Multivariate linear regression modeling was performed. RESULTS. Completed questionnaire data were available for 482 of the 672 patients. In 176 women, silicone implants were placed and in 306, saline implants were used. The multivariate model confirmed that patients' satisfaction with their breasts was significantly higher in patients with silicone implants (P ¼ .016). The receipt of postmastectomy radiotherapy was found to have a significant, negative effect on breast satisfaction (P<.000) in both silicone and saline implant recipients. In addition, for women who received either silicone or saline implants, satisfaction diminished over time (P ¼ .017). CONCLUSIONS. In the setting of postmastectomy reconstruction, patients who received silicone breast implants reported significantly higher satisfaction with the results of reconstruction than those who received saline implants. This information can be used to optimize shared medical decision-making by providing patients with realistic postoperative expectations. Cancer 2010;116:5584-91.

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Section: Discussionmentioning

confidence: 99%

Patient satisfaction with postmastectomy breast reconstruction

McCarthy¹,

Klassen²,

Cano³

et al. 2010

Cancer

116

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“…Immediate breast reconstruction without radiotherapy, offers enhanced aesthetic and safe oncological outcomes, is more cost-effective and provides a positive psychological effect [12][13][14][15][16]. Despite this, less than 20% of patients having a mastectomy have immediate breast reconstruction in the United States [2].…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy and breast reconstruction: a meta-analysis

Barry

Kell

2011

Breast Cancer Res Treat

228

126

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To cite this version:M Barry, M. R. Kell. Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Research and Treatment, Springer Verlag, 2011, 127 (1) databases were searched and cross-referenced for appropriate studies where morbidity following BR was the primary outcome measured.. Results:1,105 patients were identified from 11 appropriately selected studies.Patients undergoing PMRT and BR are more likely to suffer morbidity compared to patients not receiving PMRT ((OR) = 4.2; 95% CI, 2.4-7.2(no PMRT vs. PMRT)). Reconstruction technique was also examined with outcome whenPMRT was delivered after BR and this demonstrated that autologous reconstruction is associated with less morbidity in this setting ((OR) = 0.21; (95% CI, 0.1-0.4 (autologous vs. implant based)). Delaying BR until after PMRT had no significant effect on outcome ((OR) =0.87; 95% CI, 0.47-1.62 (delayed vs. immediate)).Conclusions: PMRT has a detrimental effect on BR outcome. These results suggest that where immediate reconstruction is undertaken with the necessity of PMRT, an autologous flap results in less morbidity when compared to implant based reconstruction. 3 INTRODUCTION:Breast Eligibility CriteriaAll trials whether randomized or non-randomized, prospective or retrospective were eligible that examined the effects of radiotherapy on immediate or delayed breast reconstruction using either a prosthesis or autologous tissue (Latissimus Dorsi (LD) or Trasversus Rectus Abdominis Muscle (TRAM). Case series orreports were not included. Studies where the data could not be accurately extracted were also excluded. Data Extraction and OutcomesThe following information regarding each eligible trial was recorded: authors' names, journal, patient numbers, timing and method of reconstruction, addition of radiotherapy and the post-operative complication rate. The primary end point of 7 this meta-analysis was postoperative morbidity including capsular contracture, fibrosis, fat necrosis, surgical site infections requiring removal of prosthesis/reoperation (see tables 2, 4 and 6). Statistical AnalysisFor post-operative complications in each study, the odds ratio (O.R.) of the simple proportions of events was estimated with its variance and 95% CI.Heterogeneity between the O.R.s for the same outcome between studies was assessed by use of the X 2 -based Q statistic [24]. Data were then combined across studies by the use of general variance methods with fixed and random effects models [14]. Analyses were conducted using StatsDirect version 2.5.6(StatsDirect Ltd, Chesire, United Kingdom) and SPSS version 12.0 (SPSS, Inc, Chicago, IL). All statistical tests were two tailed. 8 RESULTS:Eligible Studies 20 potentially eligible studies were identified that examined the effects of radiotherapy on immediate or delayed breast reconstructions. 9 studies were excluded from the meta-analysis due to low numbers (e.g. n < 15) or incomplete data set regarding postoperative morbidity. Of the 11 studies selected, 4 were studies that examined the effects of RT...

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“…Immediate breast reconstruction (IBR) is performed to improve body image and the remaining quality of life for women facing mastectomy [1][2][3][4]. Success can be defined as the best possible cosmetic result that does not sacrifice oncological safety [5,6].…”

Section: Introductionmentioning

confidence: 99%

New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study

Giacalone

Rathat

Daurès

et al. 2010

Breast Cancer Res Treat

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Feasibility and oncological safety of postadjuvant skin-sparing mastectomy (SSM) plus immediate breast reconstruction (IBR) cannot be evaluated by randomized trials. However, comparative study could modify guidelines for the oncosurgical treatment of invasive breast cancer. Our study compared the feasibility, oncological safety and esthetic outcome of SSM plus latissimus dorsi (LD) flap IBR after chemotherapy (CT) and radiotherapy (RT) with the standard management for invasive breast cancer: mastectomy as primary treatment, adjuvant CT and RT, and LD flap delayed breast reconstruction (DBR). Twenty-six selected patients with stages IIA-IIIA breast cancer were offered post-neoadjuvant SSM plus IBR with LD flap plus implant (IBR group). Seventy-eight other patients had primary mastectomy, adjuvant CT and RT, and LD-assisted DBR (DBR group). After 4.1 years (range 1-8) of follow-up, feasibility, oncological safety, and esthetic outcome were compared. Sixteen (61%) early complications were reported for the IBR group versus 44 (56%) for the DBR group (P = 0.645). Early implant loss was 0% in IBR versus 12% in DBR. IBR had 8 (30%) late complications versus 17 (21%) for DBR (P = 0.362). Capsular contracture and reconstruction failure rates were similar. Local recurrence was 7.7% (2/26) in IBR and 6.4% (5/78) in DBR (P = 0.823). Cosmetic evaluation by independent physicians and by the patients themselves was identical in the two groups. Our concept provides a basis for offering more women the opportunity to elect for immediate reconstruction, even in the setting of radiation therapy.

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Effects of Immediate Breast Reconstruction on Psychosocial Morbidity After Mastectomy

Cited by 371 publications

References 5 publications

Patient satisfaction with postmastectomy breast reconstruction

Patient satisfaction with postmastectomy breast reconstruction

Radiotherapy and breast reconstruction: a meta-analysis

New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study

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