Increasing use of mastectomy with immediate reconstruction and contralateral prophylactic mastectomy in breast-conservation candidates: A 14-year report from a comprehensive cancer center.

Dragun, AE; Pan, Judy; Riley, Elizabeth; Kruse, Barbara; Wilson, M. R.; Rai, Simerjit; Jain, Dharamvir

doi:10.1200/jco.2011.29.15_suppl.1104

Cited by 14 publications

(17 citation statements)

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“…The mastectomy rate in the United States has been steadily increasing, including the rate for contralateral prophylactic mastectomy and elective mastectomy [1][2][3][4][5] . Mastectomies permanently alter a patient's body image and thereby impact self-esteem [6] .…”

Section: Introductionmentioning

confidence: 99%

Larger breast implants warranted for post-mastectomy reconstruction

Howarth¹,

Rodriguez²,

Gargya³

et al. 2017

PAR

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Our goal was to ascertain if there was a role for larger breast implants in breast reconstruction. Methods: Patients that underwent mastectomy and implant-based breast reconstruction were identified and reviewed. Results: Of the total specimens, 92 (14.7%) weighed more than 800 g with a mean weight of 1140 g (range 803 to 2177 g). Of the patients with these larger specimens, 45 (48.9%) selected the largest available implants (800 mL implants) for their reconstruction. Conclusion: There are patients undergoing mastectomy and implant-based breast reconstruction who are unable to have reconstruction to their native breast volume because of the current implant-volume restrictions.

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Section: Introductionmentioning

confidence: 99%

Larger breast implants warranted for post-mastectomy reconstruction

Howarth¹,

Rodriguez²,

Gargya³

et al. 2017

PAR

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“…These patients have also seen a concurrent increase in immediate breast reconstruction, which is associated with better quality of life. 2,5,6 Furthermore, the rates of contralateral prophylactic and bilateral prophylactic mastectomies increased by 15% and 12% per year, respectively, between 1998 and 2008. Factors associated with contralateral and bilateral mastectomy include Caucasian race, household income greater than US $64,000, and those with private health insurance.…”

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confidence: 99%

Immediate Bilateral Breast Reconstruction Using Abdominally Based Flaps: An Analysis of the Nationwide Inpatient Sample Database

Holoyda

Simpson

et al. 2019

J reconstr Microsurg

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Background Bilateral mastectomy rates are increasing in the United States. The abdomen is the most common harvest site for autologous reconstruction. Nationwide data were examined to determine differences in hospital charges, length of stay (LOS), and early postoperative complications following immediate bilateral pedicled transverse rectus abdominis myocutaneous (pTRAM), free TRAM (fTRAM), deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) perforator flaps and were compared with unilateral reconstruction. Methods Patients who underwent immediate bilateral breast reconstruction using a single method of abdominally based reconstruction were identified using the 2009 to 2014 Nationwide Inpatient Sample Database. Outcomes included total hospital charges, LOS, and immediate postoperative complications. Results We identified 13,348 cases of bilateral mastectomy with a single type of immediate bilateral autologous flap reconstruction. The majority were bilateral DIEP flaps. Mean total cost for bilateral pTRAM, fTRAM, DIEP, and SIEA flaps was US $21,886.80, US $28,839.40, US $30,051.30, and US $33,784.90, respectively (p < 0.0001). Mean LOS for bilateral pTRAM, fTRAM, DIEP, and SIEA was 4.3, 4.9, 4.5, and 5.4 days, respectively (p = 0.0002), and hematoma rates were 1.93, 2.61, 3.68, and 16.59%, respectively, (p = 0.0001), whereas return to the operating room for vascular anastomosis revision was 0, 1.63, 1.99, and 19.07%, respectively (p < 0.0001). Cost is less for unilateral pTRAM, fTRAM, and DIEP flaps (p < 0.0001). LOS is shorter for unilateral fTRAM versus bilateral (p < 0.0001). No differences were appreciated between unilateral and bilateral hematoma and reoperation rates for any reconstruction (p > 0.1). Conclusion Immediate complication rates were higher in bilateral free flaps compared with bilateral pedicled flaps. pTRAM and fTRAM flap reconstructions are still performed frequently with acceptable immediate results without considering long-term morbidity, aesthetics, and abdominal muscle function. Bilateral SIEA free flaps were associated with significantly higher total cost, LOS, and complication rates compared with other groups. Complications were similar between unilateral and bilateral reconstruction procedures. While cost is significantly greater for bilateral procedures compared with unilateral pTRAM, fTRAM, and DIEP flaps, it is not doubled.

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“…mastectomy have been noted. 2,3 Paired with this increase in mastectomies is an increasing rate of breast reconstruction; 3,4 this is important, as reconstruction represents an invaluable part of breast cancer surgery and treatment, with data consistently demonstrating improvements in quality of life and cosmetic satisfaction with reconstruction. 5 Some patients undergoing mastectomy and reconstruction will require postmastectomy radiation therapy (PMRT), with benefits of PMRT including reduced locoregional recurrence and improved survival.…”

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confidence: 99%