Recent trends and predictors in immediate breast reconstruction after mastectomy in the United States

Reuben, Brian; Manwaring, Jotham; Neumayer, Leigh

doi:10.1016/j.amjsurg.2008.11.034

Cited by 139 publications

(96 citation statements)

References 13 publications

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“…Reuben et al demonstrated that immediate reconstruction was more likely to happen in the younger (less than 50 years) white patient who was seeking medical care in an urban versus a rural hospital. 8 These patients were also more likely to be educated, employed, and married. 7,8 However, recently there has been an increase in breast reconstruction among older patients (greater than 65 years), probably related to greater awareness and changes in provider bias.…”

Section: Disparities and Psychologic Effects Of Mastectomymentioning

confidence: 99%

“…8 These patients were also more likely to be educated, employed, and married. 7,8 However, recently there has been an increase in breast reconstruction among older patients (greater than 65 years), probably related to greater awareness and changes in provider bias. 8 Patients who did not undergo immediate reconstruction were more likely to be older, with multiple comorbidities and receiving care in a nonteaching hospital.…”

Section: Disparities and Psychologic Effects Of Mastectomymentioning

confidence: 99%

“…8 Patients who did not undergo immediate reconstruction were more likely to be older, with multiple comorbidities and receiving care in a nonteaching hospital. 8 With regard to race, patients who were African American were more unlikely to get immediate reconstruction in comparison with White, Hispanic, and Native American patients.…”

Section: Disparities and Psychologic Effects Of Mastectomymentioning

confidence: 99%

“…7,8 However, recently there has been an increase in breast reconstruction among older patients (greater than 65 years), probably related to greater awareness and changes in provider bias. 8 Patients who did not undergo immediate reconstruction were more likely to be older, with multiple comorbidities and receiving care in a nonteaching hospital. 8 With regard to race, patients who were African American were more unlikely to get immediate reconstruction in comparison with White, Hispanic, and Native American patients.…”

Section: Disparities and Psychologic Effects Of Mastectomymentioning

confidence: 99%

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Breast reconstruction: current and future options

Paul

Prendergast

Nicholson

et al. 2011

BCTT

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Abstract:When initiated by the devastating diagnosis of cancer, post ablative breast restoration has at its core the goal of restoring anatomic normalcy. The concepts of body image, wholeness, and overall well-being have been introduced to explain the paramount psychological influence the breast has on both individuals and society as a whole. Hence, a growing subspecialty has been established to recreate or simulate the lost breast. At least one third of breast cancer victims consider breast reconstruction. Breast reconstruction post mastectomy may be offered at the time of mastectomy or delayed post mastectomy after adjuvant therapy. This may be utilizing autologous tissues or implants and each has risks and benefits, especially when considering adjuvant therapy. In addition, there has been a move away from a traditional mastectomy to less invasive, but still curative procedures, such as skin-sparing and nipple-sparing mastectomy. These procedures provide the breast envelope to facilitate reconstruction. This paper reviews the primary issues in breast reconstruction, as well as their psychologic, oncologic, and social impact. Keywords: breast restoration, body image, breast reconstruction, mastectomy History of breast reconstructionBreast cancer is the second leading cause of cancer-related death among females in the US, and affects one in eight women in their lifetime.1,2 Advances in medical research have dramatically improved the treatment of this disease over the last 50 years. In addition to chemotherapy and radiation therapy, partial and complete mastectomy of diseased and contralateral breasts has become more frequent. However, these surgical modalities often leave patients with anatomical deformities and altered body image, along with the psychologic impact. 3,4 Breast reconstruction is a dynamic and multidisciplinary approach that has grown into a solution for many breast cancer patients treated with surgery. Breast reconstruction began as a means to reduce chest wall complications and deformities from mastectomy, with the goal to recreate symmetry and contour while avoiding delay in adjuvant cancer treatment.1 Breast reconstruction was introduced over a century ago as a surgical modality for rebuilding the anatomic breast using autologous tissues and prosthetic implants. 2,5

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Section: Disparities and Psychologic Effects Of Mastectomymentioning

confidence: 99%

Section: Disparities and Psychologic Effects Of Mastectomymentioning

confidence: 99%

Section: Disparities and Psychologic Effects Of Mastectomymentioning

confidence: 99%

Section: Disparities and Psychologic Effects Of Mastectomymentioning

confidence: 99%

See 2 more Smart Citations

Breast reconstruction: current and future options

Paul

Prendergast

Nicholson

et al. 2011

BCTT

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“…Tobacco use should be discontinued 6-8 weeks prior to OBS procedures with NAC containing flap oncoplastic reduction and volume expansion. Despite oncological and aesthetic benefits, patient preference regarding simultaneous OBS varies with age, race, education and socio-economic status (33). Potential oncologic and aesthetic risks should be explained to the patient in an appropriate and unbiased manner.…”

Section: A-breast Volume Displacement;mentioning

confidence: 99%

The Role of Oncoplastic Breast Surgery in Breast Cancer Treatment

Emiroğlu¹,

Sert²,

Inal

2015

J Breasth Health

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The aim of this study is to discuss indications, advantages, disadvantages, oncologic and aesthetic results of Oncoplastic Surgery (OBS). Pubmed and Medline database were searched for articles published between 1998 and 2014 for keywords: oncoplastic breast surgery, therapeutic mammoplasty, oncoplastic breast reduction, synchrenous reconstructions. Role of OBS in breast cancer surgery, its aspects to be considered, its value and results have been interpreted. This technique has advantages by providing more extensive tumourectomy, yielding better aesthetic results compared with breast conserving surgery, allowing oncoplastic reduction in breast cancer patients with macromastia, with higher patient satisfaction and quality of life and by being inexpensive due to single session practice. As for its disadvantages are: re-excision is more difficult, risk for mastectomy is higher, it is depent on the Surgeron's experience, it has a risk for delay in adjuvant therapies and its requirement for additional imaging studies during management. Main indications are patients with small tumour / breast volume, macromastia, multifocality, procedures which can disrupt breast cosmesis such as surgeries for upper inner breas tquadrient tumours. Contraindications are positive margin problems after wide excision, diffuse malign microcalsifications, inflammatory breast cancer, history of radiotherapy and patients' preferences. Despite low evidence level, Oncoplastic Breast Surgery seems to be both reliable and acceptable in terms of oncologic and aesthetic aspects. Oncoplastic Breast Surgery increase the application rate of breast conserving surgery by obviating practical limitations and improve the results of breast conserving surgery. Correct patient and technique choice in OBS is vital for optimization of post surgical

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Temporal Trends in Postmastectomy Radiation Therapy and Breast Reconstruction Associated With Changes in National Comprehensive Cancer Network Guidelines

et al. 2016

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Importance Evolving data on the effectiveness of post-mastectomy radiation therapy (PMRT) have led to changes in NCCN recommendations, counseling providers to “strongly consider” PMRT for breast cancer patients with tumors ≤5cm and 1-3 positive nodes; however, anticipated PMRT may lead to delay or omission of reconstruction which can have cosmetic, quality of life, and complication implications for patients. Objective To determine whether revised guidelines have increased PMRT and impacted receipt of breast reconstruction. We hypothesized that: 1) PMRT would increase for women affected by the revised guidelines while remaining stable in other cohorts, and 2) that these women would have decreased receipt of breast reconstruction while reconstruction increased in other groups. Design A retrospective, population-based cohort study Setting Surveillance, Epidemiology, and End Results (SEER) data from 2000 – 2011. Participants Women with stage I-III breast cancer undergoing mastectomy were identified. Our analytic sample (n=62,442) was divided into cohorts based on current NCCN radiation recommendations: “Radiation Recommended” (tumors >5 cm or ≥4 positive lymph nodes), “Strongly Consider Radiation” (tumor ≤5cm, 1-3 positive nodes), and “Radiation Not Recommended” (tumors ≤5cm, no positive nodes). Main Outcome Measure(s) We used joinpoint regression analysis to evaluate temporal trends in our outcomes of interest: receipt of PMRT and receipt of breast reconstruction. Results Rates of PMRT were unchanged in the “Radiation Recommended” and “Radiation Not Recommended” cohorts over the study period. In contrast, receipt of PMRT for the “Strongly Consider Radiation” cohort was unchanged until 2007, then significantly increased (APC 9.0%, p=0.013). Breast reconstruction increased across all cohorts. Despite increasing receipt of PMRT, the “Strongly Consider Radiation” cohort maintained a consistent increase in reconstruction (APC 7.5%) throughout the study period. This is similar to the increase in reconstruction observed for the “Radiation Recommended” (10.7%) and “Radiation Not Recommended (8.4%) cohorts. Conclusions and Relevance NCCN guideline changes have increased PMRT receipt for patients with tumors ≤5cm and 1-3 positive nodes without an associated decrease in receipt of reconstruction. This may represent increasing provider comfort with the prospect of irradiating a new breast reconstruction, and may have significant cosmetic and quality of life implications for patients.

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Recent trends and predictors in immediate breast reconstruction after mastectomy in the United States

Cited by 139 publications

References 13 publications

Breast reconstruction: current and future options

Breast reconstruction: current and future options

The Role of Oncoplastic Breast Surgery in Breast Cancer Treatment

Temporal Trends in Postmastectomy Radiation Therapy and Breast Reconstruction Associated With Changes in National Comprehensive Cancer Network Guidelines

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