Quality-of-Life Outcomes between Mastectomy Alone and Breast Reconstruction

Eltahir, Yassir; Werners, Lisanne L. C. H.; Dreise, Marieke M.; Emmichoven, Ingeborg A. Zeijlmans van; Jansen, Liesbeth; Werker, Paul M. N.; Bock, Geertruida H. de

doi:10.1097/prs.0b013e31829586a7

Cited by 264 publications

(100 citation statements)

References 25 publications

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“…Women often undergo breast reconstruction to feel normal and improve self-esteem (Flitcroft et al, 2016; Flitcroft, Brennan, & Spillane, 2017). However, longitudinal studies suggest that for some women, breast reconstruction may be associated with worse psychological functioning (Metcalfe et al, 2015; Nissen et al, 2001) and dissatisfaction with body image (Eltahir et al, 2013; Howes et al, 2016; Metcalfe et al, 2012). Recovery time, degree of pain, and aesthetic outcomes can have a significant impact on quality of life (Spector, Mayer, Knafl, & Pusic, 2011; Winters, Benson, & Pusic, 2010; Zhong et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Met and Unmet Expectations for Breast Reconstruction in Early Posttreatment Breast Cancer Survivors

Steffen

Johnson

Levine

et al. 2017

Plastic Surgical Nursing

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Background The purpose of this study was to evaluate the prevalence of met and unmet expectations after breast reconstruction among breast cancer survivors following mastectomy. A secondary objective was to examine women’s reasons their experiences of reconstructive surgery were better or worse than expected. Methods As part of a larger study of breast cancer survivors, participants completed self-administered questionnaires within 8 months of diagnosis and at 6, 12, and 18 months later. At the 18-month follow-up, women who had breast reconstruction were asked whether their reconstruction was better, the same, or worse than expected. Results The sample consisted of 130 survivors (mean age 48.5 years) who had breast reconstruction following a mastectomy and completed the 18-month follow-up, 42% of whom reported their reconstruction was worse than expected and only 25% reported it was better. Most frequently reported reasons for reconstruction being worse than expected were related to appearance of the reconstructed breast and pain. Conclusions A high percentage of breast cancer patients undergoing breast reconstruction following a mastectomy report the results as worse than expected with the primary reasons for dissatisfaction related to the feel and appearance of the reconstructed breast. Breast cancer patients considering breast reconstruction need better pre-operative education or understanding about what to expect from reconstruction.

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Section: Introductionmentioning

confidence: 99%

Met and Unmet Expectations for Breast Reconstruction in Early Posttreatment Breast Cancer Survivors

Steffen

Johnson

Levine

et al. 2017

Plastic Surgical Nursing

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“…There is increasing evidence that microvascular breast reconstruction is associated with improved quality of life and cosmetic outcomes for some patients, when compared to prosthetic reconstruction or mastectomy alone. [10–14] However, patients undergoing microvascular reconstruction have an increased susceptibility for systemic thromboembolic events given the prolonged duration of surgery, hospital length of stay, and period of non-ambulatory time following surgery. [13,15,16,14,17] In addition to systemic events, the hypercoagulable circulatory environment potentiated by tamoxifen may impact the microvascular anastomosis and contribute to thrombotic flap complications, including total flap loss.…”

Section: Introductionmentioning

confidence: 99%

Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction: a systematic review and meta-analysis

Parikh

Odom

et al. 2017

Breast Cancer Res Treat

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Purpose Tamoxifen therapy is integral in the treatment of patients with hormone receptor-positive breast cancer. However, there is an association between tamoxifen and thromboembolic events. Flap and systemic thromboembolic events have devastating consequences in microvascular breast reconstruction. Currently, there is conflicting data on the association between tamoxifen therapy and thromboembolic complications for patients undergoing microvascular breast reconstruction. The objective of this study is to determine if perioperative tamoxifen therapy modifies the risk of complications and thromboembolic events for patients with breast cancer undergoing microvascular breast reconstruction. Methods A comprehensive literature search was performed across 6 databases from January 2003 to February 2016. Pooled estimates and relative risk (RR) were calculated using a random-effects model, confounding was examined with meta-regression, and risk of bias was evaluated. Primary outcomes were thrombotic flap complications and total flap loss. Study quality was assessed using Downs and Black criteria. Results Of 95 studies reviewed, 4 studies comprising 1700 patients and 2245 procedures were included for analysis. Compared to non-recipients, patients on tamoxifen were at increased risk of developing thrombotic flap complications (pooled RR: 1.5; 95% CI: 1.14–1.98) and total flap loss (pooled RR: 3.35; 95% CI: 0.95–11.91). There was no significant heterogeneity present in either outcome and no evidence of publication bias. Conclusions Perioperative tamoxifen therapy may increase the risk of thrombotic flap complications and flap loss for patients with breast cancer undergoing microvascular reconstruction. These findings further the ability of providers to make evidence-based recommendations in the perioperative management of patients with breast cancer.

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“…The disfiguring nature of this procedure often induces physical and psychological distress and may lead to significant chronic postmastectomy pain (3-8). Breast reconstruction offers patients an option that can help them move past the trauma of cancer and loss of psychological and social wellbeing following mastectomy (9). Breast reconstruction following mastectomy has increased 21% since 2000, with over 95,000 reconstructions performed in 2013 (10).…”

Section: Introductionmentioning

confidence: 99%

Treatment of Post-Latissimus Dorsi Flap Breast Reconstruction Pain With Continuous Paravertebral Nerve Blocks: A Retrospective Review

2016

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ObjectivesThe addition of a perioperative continuous paravertebral nerve block (cPVB) to a single-injection thoracic paravertebral nerve block (tPVB) has demonstrated improved analgesia in breast surgery. However, its use following isolated post-mastectomy reconstruction using a latissimus dorsi flap (LDF) has not previously been examined.MethodsWe performed a retrospective review of patients who underwent salvage breast reconstruction with a unilateral LDF by a single surgeon. Preoperatively, all patients received a single-injection tPVB with 0.5% ropivacaine. Additionally, patients had the option for catheter placement to receive a continuous 0.2% ropivacaine infusion with intermittent boluses. Infusions commenced in the recovery room and the catheters were removed on the morning of discharge. The primary endpoint was the mean pain numeric rating scale (NRS) scores for the 24-hour period beginning at 7:00 on post-operative day 1.ResultsA total of 22 patients were included in this study (11-cPVB and 11-tPVB). The mean NRS pain score of cPVB patients (3.5 (standard deviation (SD) 1.8) was lower than that of the single-injection tPVB patients (4.4 (SD 2.1), however this difference was not statistically significant (P = 0.31). The length of hospital stay and opioid use was not statistically different between groups.ConclusionsPatients receiving a cPVB in addition to tPVB after LDF reconstruction experienced similar pain to those receiving tPVB alone. A larger, randomized clinical trial is warranted to fully determine the benefits of using cPVB in addition to tPVB for this procedure.

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Quality-of-Life Outcomes between Mastectomy Alone and Breast Reconstruction

Abstract: Therapeutic, III.

Cited by 264 publications

References 25 publications

Met and Unmet Expectations for Breast Reconstruction in Early Posttreatment Breast Cancer Survivors

Met and Unmet Expectations for Breast Reconstruction in Early Posttreatment Breast Cancer Survivors

Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction: a systematic review and meta-analysis

Treatment of Post-Latissimus Dorsi Flap Breast Reconstruction Pain With Continuous Paravertebral Nerve Blocks: A Retrospective Review

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