Patient-Reported Outcomes Are Better after Oncoplastic Breast Conservation than after Mastectomy and Autologous Reconstruction

Chand, Natalie; Browne, Victoria Rowena; Paramanathan, Nirmala; Peiris, Lashan; Laws, Siobhan; Rainsbury, Richard

doi:10.1097/gox.0000000000001419

Cited by 57 publications

(34 citation statements)

References 41 publications

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“…With the rise of reconstructive surgery, aesthetic satisfaction has become an important factor influencing patient decision making when considering surgical treatment choices for breast cancer removal [22]. Although both M+R and OS inherently represent reconstructive techniques, OS has higher patient satisfaction [19, 20] and has also been shown to be cost-effective [23, 24]. Collectively, these fundamental principles may influence a patient’s decision for breast reconstruction, and thereby explain the trends seen in our present analysis [6, 12].…”

Section: Discussionmentioning

confidence: 99%

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Jonczyk

Jean

Graham

et al. 2018

Breast Cancer Res Treat

156

118

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Purpose Breast cancer surgical techniques are evolving. Few studies have analyzed national trends for the multitude of surgical options that include partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with reconstruction (M+R), and PM with oncoplastic reconstruction (OS). We hypothesize that the use of M is declining and likely correlates with the rise of surgery with reconstructive options (M+R, OS). Methods A retrospective cohort analysis was conducted using the ACS-NSQIP database from 2005 to 2016 and ICD codes for IBC and DCIS. Patients were then grouped together based on current procedural terminology (CPT) codes for PM, M, M+R, and OS. In each group, categories were sorted again based on additional reconstructive procedures. Data analysis was conducted via Pearson’s chi-squared test for demographics, linear regression, and a non-parametric Mann-Kendall test to assess a temporal trend. Results The patient cohort consisted of 256,398 patients from the NSQIP data base; 197,387 meet inclusion criteria diagnosed with IBC or DCIS. Annual breast surgery trends changed as follows: PM 46.3–46.1% (p = 0.21), M 35.8–26.4% (p = 0.001), M+R 15.9–23.0% (p = 0.03), and OS 1.8–4.42% (p = 0.001). Analyzing the patient cohort who underwent breast conservation, categorical analysis showed a decreased use of PM alone (96–91%) with an increased use of OS (4–9%). For the patient cohort undergoing mastectomy, M alone decreased (69–53%); M+R with muscular flap decreased (9–2%); and M+R with implant placement increased (20–40%)—all three trends p < 0.0001. Conclusion The modern era of breast surgery is identified by the increasing use of reconstruction for patients undergoing breast conservation (in the form of OS) and mastectomy (in the form of M+R). Our study provides data showing significant trends that will impact the future of both breast cancer surgery and breast training programs.

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Section: Discussionmentioning

confidence: 99%

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Jonczyk

Jean

Graham

et al. 2018

Breast Cancer Res Treat

156

118

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“…There is, however, limited high‐quality comparative evidence to support the benefits of TM as an alternative to mastectomy with or without IBR. Single‐centre case series have suggested that, overall, patients undergoing TM may report better quality of life than those undergoing mastectomy and IBR. There is emerging evidence to suggest that TM may be a cost‐effective alternative to mastectomy and immediate implant‐based and free‐flap reconstruction in a North American setting.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

Potter

Trickey

Rattay

et al. 2020

British Journal of Surgery

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Background: Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR. Methods:The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy.Results: A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21⋅0 per cent; mastectomy: 570, 37⋅2 per cent; mastectomy and IBR: 359, 35⋅6 per cent; P < 0⋅001). Breast conservation was possible in 87⋅0 per cent of patients who had TM, and TM did not delay adjuvant treatment.Conclusion: TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety. * Members of the iBRA-2 and TeaM Steering Groups, the Breast Reconstruction Research Collaborative, and the Mammary Fold Academic and Research Collaborative are co-authors of this study and are listed in Appendix S1 (supporting information) Earlier versions of the combined analysis were presented to the

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“…Breast reconstruction (OPS or M + R) offers patients an improved quality of life by providing an aesthetically symmetric breast together with higher patient satisfaction [2,3,4]. Unfortunately, complication rates persist in breast cancer surgery and vary (2–40%) with the type of reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Trending Towards Safer Breast Cancer Surgeries? Examining Acute Complication Rates from A 13-Year NSQIP Analysis

Jonczyk

Jean

Graham

et al. 2019

Cancers

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As breast cancer surgery continues to evolve, this study highlights the acute complication rates and predisposing risks following partial mastectomy (PM), mastectomy(M), mastectomy with muscular flap reconstruction (M + MF), mastectomy with implant reconstruction (M + I), and oncoplastic surgery (OPS). Data was collected from the American College of Surgeons NSQIP database (2005–2017). Complication rate and trend analyses were performed along with an assessment of odds ratios for predisposing risk factors using adjusted linear regression. 226,899 patients met the inclusion criteria. Complication rates have steadily increased in all mastectomy groups (p < 0.05). Cumulative complication rates between surgical categories were significantly different in each complication cluster (all p < 0.0001). Overall complication rates were: PM: 2.25%, OPS: 3.2%, M: 6.56%, M + MF: 13.04% and M + I: 5.68%. The most common predictive risk factors were mastectomy, increasing operative time, ASA class, BMI, smoking, recent weight loss, history of CHF, COPD and bleeding disorders (all p < 0.001). Patients who were non-diabetic, younger (age < 60) and treated as an outpatient all had protective OR for an acute complication (p < 0.0001). This study provides data comparing nationwide acute complication rates following different breast cancer surgeries. These can be used to inform patients during surgical decision making.

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Patient-Reported Outcomes Are Better after Oncoplastic Breast Conservation than after Mastectomy and Autologous Reconstruction

Abstract: Supplemental Digital Content is available in the text.

Cited by 57 publications

References 41 publications

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

Trending Towards Safer Breast Cancer Surgeries? Examining Acute Complication Rates from A 13-Year NSQIP Analysis

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