Cost and Outcome Analysis of Breast Reconstruction Paradigm Shift

Fitzpatrick, Aisling M; Gao, Lin; Smith, Barbara L.; Cetrulo, Curtis L.; Colwell, Amy S.; Winograd, Jonathan M.; Yaremchuk, Michael J.; Austen, William G.; Liao, Eric C.

doi:10.1097/sap.0b013e318276d979

Cited by 30 publications

(18 citation statements)

References 53 publications

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“…This is consistent with previously reported trends in the United States and Canada . Regression analysis demonstrated that younger patients were significantly more likely to receive immediate breast reconstruction, which is consistent with previous literature . Patients with a cancer diagnosis were also less likely to receive IBR.…”

Section: Discussionsupporting

confidence: 91%

“…A significant shift in breast reconstruction following mastectomy has occurred in the last decade with an increase in the number of women undergoing mastectomy and immediate implant‐based reconstruction; this is particularly occurring in younger women . One of the challenges with implant‐based reconstruction is the potential need for adjuvant radiation therapy and the subsequent risk of complications, such as reconstruction failure, capsular contracture, infection, implant exposure, and mastectomy flap necrosis .…”

Section: Introductionmentioning

confidence: 99%

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Trends in immediate breast reconstruction and radiation after mastectomy: A population study

et al. 2020

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In the last decade, there has been an increase in women undergoing immediate breast reconstruction (IBR) at the time of mastectomy. Recent literature suggests a shift in practice: Surgeons are becoming more comfortable with IBR in the setting of possible postoperative adjuvant radiotherapy, despite the known complications. This study sought to investigate, at a population level, the patient and surgeon characteristics associated with the use of IBR and which of these factors were predictive of adjuvant radiotherapy. This retrospective population‐based cohort study included all adult women who underwent mastectomy in the province of Ontario from 2007 to 2014. The Canadian Institute for Health Information (CIHI) administrative data base was used to generate patient demographic and clinical data. The Ontario Health Insurance Plan (OHIP) data base was used to elicit surgeon characteristics including clinical experience and volume of practice dedicated to breast surgery. Outcome variables included reconstruction concurrent with mastectomy, alloplastic vs autologous reconstruction, and use of radiation. A total of 25 861 patients underwent mastectomy and 2972 had IBR (11.5%). The rate of IBR after mastectomy increased over time from 7.2% in 2007 to 17.2% in 2014 (P < .001). There was also an increase in the proportion of patients with IBR who received radiation over the time period, from 19.4% in 2007 to 28.2% in 2014 (P = .003). In the first regression analysis, IBR was associated with younger patient age, residing in closer proximity to cancer clinics, absence of malignant breast disease (ie, prophylactic mastectomy), having a younger surgeon performing the mastectomy, and receiving care at a teaching hospital. A second analysis showed that patient variables predictive of radiation after IBR were a younger age and a more advanced cancer stage and no variables specific to surgeon or institution were predictive of radiation in patients with IBR. A significant increase in the rate of IBR as well as the use of radiation occurred over the 7‐year study period. Multiple patient and surgeon factors were associated with IBR. Variables associated with radiation in IBR were harder to predict. Given the increase in the use of radiation in IBR, further research is needed to look at long‐term outcomes in these patients at the population level.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Trends in immediate breast reconstruction and radiation after mastectomy: A population study

et al. 2020

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“…Recent studies in the United States have shown a dramatic increase in prosthetic breast reconstruction from 40% to 74% 12 , 18 , 19 partly due to the changed mastectomy patterns – a 15% and 12% per year increased application of contralateral and bilateral prophylactic mastectomies. 18 However, this is not the case in China for multiple reasons, such as the lack of public awareness, scientific guidelines, and the feasibility of tests for breast cancer; 1/2 gene mutation, as well as cultural differences.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Breast Reconstruction in Southern China

et al. 2015

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The study of this study is to assess the current status and trend of the application of breast reconstruction in China.A retrospective review of all patients who had received surgical treatment for breast cancer in the Fudan University Shanghai Cancer Center between January 1999 and June 2014 was performed. The clinicopathological and epidemiological parameters and the follow-up information of each patient were collected.A total of 20,551 patients with 20,974 surgeries were identified. Of those, the rates of patients received mastectomy, breast conserving therapy, and breast reconstruction were 81.2% (17,040 cases), 15.3% (3216 cases), and 3.4% (718 cases), respectively. Skin-sparing mastectomy with autologous breast reconstruction was algate the dominant option for breast reconstruction although a rapid growth in the application of prosthetic reconstructions was observed in recent years. The rates of complications that required reoperation in patients reconstructed with latissimus dorsi myocutaneous flap, pedicled transverse rectus abdominis myocutaneous flap, free flaps, and prosthesis were 1.2%, 8.5%, 11.4%, and 10.5%, respectively, while the revision rates were 0.7%, 6.1 %, 5.3%, and 2.3%, respectively. Multiple regression analysis confirmed that types of surgery did not affect the disease-free survival of breast cancer patients.Skin-sparing mastectomy with breast reconstruction is oncologically safe while achieving satisfactory aesthetic outcomes. Autologous reconstruction remains the most commonly used technique while there is a rapid increase of prosthetic reconstruction in recent years. The low demand for breast aesthetics among Chinese women, defects of healthcare system, and the limited availability of recourses impeded the development of breast reconstruction techniques in China.

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“…Patterns of care in Canada show more women are choosing bilateral, single‐stage and prosthesis‐based reconstructions . Though autologous reconstructions have many applications, especially in the delayed or radiated woman, their use in immediate reconstruction has decreased.…”

Section: Discussionmentioning

confidence: 99%