Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting

Abstract

IntroductionThe National Institute for Health and Clinical Excellence guidelines recommend that breast reconstruction should be available to all women undergoing mastectomy and discussed at the initial surgical consultation (2002, and updated 2009). The National Mastectomy and Breast Reconstruction Audit (2009) showed that 21% of mastectomy patients underwent immediate breast reconstruction (IBR) and 11% had delayed breast reconstruction (DBR). Breast reconstruction has been shown to have a positive effect on quality of life postmastectomy. This retrospective study investigated the impact of the introduction of a dedicated oncoplastic multidisciplinary meeting (OP MDM) on our unit’s breast reconstruction rate.Patients and methodsA retrospective analysis of 229 women who underwent mastectomy, of whom 81 (35%) underwent breast reconstruction between April 2014 and March 2016. Data were analyzed before and after introduction of OP MDM in April 2015. Data on patient age, type of surgery (mastectomy only, mastectomy and reconstruction), timing of reconstruction (IBR, DBR), and type of reconstruction (implant, autologous) were collected.ResultsBetween April 2015 and March 2016, following establishment of OP multidisciplinary team in April 2015, of the 120 patients who had mastectomy, 50 (42%) underwent breast reconstruction with 78% (39/50) choosing IBR (56% implant reconstruction and 22% autologous). Compared to the period between April 2014 and March 2015 preceding the OP MDM, of 109 patients who underwent mastectomy, only 31 (28%) had breast reconstruction with 64% (20/31) choosing IBR (45% implant reconstruction and 19% autologous). The rate of DBR was lower, 22% (11/50), following OP MDM compared to 35% (11/31) before OP MDM.ConclusionThere has been an increased uptake of breast reconstruction surgery from 28% to 42%. The biggest impact was on those opting for the immediate type reconstruction option (78%). The OP MDM has significantly contributed to this increased rate of reconstruction.

The impact of tumor board on breast cancer care: evidence from a systematic literature review and a meta-analysis

“…Four out of 14 studies (29%) were from the USA [5,16,23,25], 3 (21%) from the UK [17,18,22]. The remaining 7 studies (50%) were from 7 different countries…”

“…Regarding the study design: 6 (43%) were historical cohort studies [5,8,21,24,25,27], 5 (36%) were before and after studies [16,19,20,22,23], 1 (7%) was a cohort study [26], 1 (7%) was a retrospective interventional cohort study [17] and 1 (7%) was an observational retrospective study [18].…”

“…Within the selected articles, the following outcomes were identi ed: diagnosis [16,19,20,23], therapy [5,16,[19][20][21][22]26]), survival [8,17,21,24,27], recurrence [24], time from visit to chemotherapy/surgery [25], prophylactic mastectomy [18], physical recovery [26], therapeutic compliance [26], MTB cost-effectiveness [27].…”

Postmastectomy Breast Reconstruction Patterns at an Urban Academic Hospital and the Impact of Surgeon Gender

“…For example, one retrospective analysis of 229 mastectomy patients from 2014 to 2016 found an increase in the reconstruction rate, from 28 beforehand to 42% afterward. 24 It should be noted that a dedicated plastic surgeon did not actively participate in the weekly MDC clinic, which may explain this unexpected finding.…”

Breast Radiotherapy after Oncoplastic Surgery—A Multidisciplinary Approach

“…Given complexities associated with incorporating oncoplastic surgery into the management paradigm, which will be explored below, we suggest that all new patients diagnosed with breast cancer be presented at the MDT prior to undertaking oncoplastic surgery [ 57 ].…”