National trends and complication rates after bilateral mastectomy and immediate breast reconstruction from 2005 to 2012

Kwok, Alvin C.; Goodwin, Isak A.; Jin, Ying; Agarwal, Jayant P.

doi:10.1016/j.amjsurg.2015.03.019

Cited by 48 publications

(37 citation statements)

References 16 publications

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“…The incidence and distribution of complications experienced in our total patient cohort is similar to previous findings . The overall complication rate is higher than some studies due to our definition of complications.…”

Section: Demographics and Past Medical History Of Patients With And Wsupporting

confidence: 88%

Incidence of complications following two‐stage expander/implant breast reconstruction: The impact of cancer diagnosis in prophylactic mastectomy

et al. 2019

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Section: Demographics and Past Medical History Of Patients With And Wsupporting

confidence: 88%

Incidence of complications following two‐stage expander/implant breast reconstruction: The impact of cancer diagnosis in prophylactic mastectomy

et al. 2019

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“…Research suggests enhanced imaging detection of sub-clinical disease, increased utilization of genetic testing, and better accessibility of reconstructive procedures have contributed to this trend, though the ultimate reasons are still not well understood [1–5]. A concomitant rise in the rate of mastectomy with immediate reconstruction (MIR) has also occurred, and currently 38% of all mastectomy cases performed annually in the United States involve reconstruction [1, 3, 4, 6]. At high-volume breast centers, reconstruction rates can be even higher, with over 60% of mastectomies undergoing reconstruction at our institution in recent years.…”

Section: Introductionmentioning

confidence: 99%

“…While breast reconstruction can improve aesthetic outcomes, patient satisfaction and quality of life [7, 8], MIR procedures have increased operative times and complication rates than mastectomies without reconstruction [4]. In the United States, MIR most commonly utilizes tissue-expander/implant-based methods according to the American Society of Plastic Surgery’s statistics[9].…”

Section: Introductionmentioning

confidence: 99%

Does “Two is Better Than One” Apply to Surgeons? Comparing Single-Surgeon Versus Co-surgeon Bilateral Mastectomies

et al. 2015

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Background Bilateral mastectomies (BM) are traditionally performed by single surgeons (SS); a co-surgeon (CS) technique, where each surgeon concurrently performs a unilateral mastectomy, offers an alternative approach. We examined differences in general surgery time (GST), overall surgery time (OST), and patient complications for BM performed by CS and SS. Methods Patients undergoing BM with tissue expander reconstruction (BMTR) between January 2010 and May 2014 at our center were identified through operative case logs. GST (incision to end of BM procedure), reconstruction duration (RST) (plastic surgery start to end of reconstruction) and OST (OST= GST + RST) was calculated. Patient age, presence/stage of cancer, breast weight, axillary-procedure performed, and 30-day postoperative complications were extracted from medical records. Differences in GST and OST between CS- and SS-cases were assessed with a t-test. A multivariate linear regression was fit to identify factors associated with GST. Results 116 BMTR cases were performed [CS, n=67 (57.8%); SS, n=49 (42.2%)]. Demographic characteristics did not differ between groups. GST and OST were significantly shorter for CS-cases, 75.8 vs. 116.8 minutes, p<0.0001, and 255.2 vs. 278.3 minutes, p=0.005, respectively. Presence of a CS significantly reduces BMTR time (β=−38.82, p<0.0001). Breast weight (β=0.0093, p=0.03) and axillary dissection (β=28.69, p=0.0003) also impacted GST. Conclusions The co-surgeon approach to BMTR reduced both GST and OST, however the degree of time-savings (35.1% and 8.3% respectively) was less than hypothesized. A larger study is warranted to better characterize time, cost, and outcomes of the CS-approach for BM.

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“…No national level study has compared trends in IBR rates and methods between patients who either receive PMRT or not [14, 15]. Such knowledge is vital for understanding current surgical practice patterns with an eye towards optimizing outcomes and developing an ideal reconstructive algorithm in radiated patients.…”

Section: Introductionmentioning

confidence: 99%

National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy

Razdan

Cordeiro

Albornoz

et al. 2017

J reconstr Microsurg

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Background Immediate breast reconstruction (IBR) is often deferred, when post-mastectomy radiotherapy (PMRT) is anticipated, due to high complication rates. Nonetheless, because of robust data supporting improved health related quality of life associated with reconstruction, physicians and patients may be more accepting of trade-offs. The current study explores national trends of IBR utilization rates and methods in the setting of PMRT, using the National Cancer Data Base (NCDB). The study hypothesis is that prosthetic techniques have become the most common method of IBR in the setting of PMRT. Methods NCDB was queried from 2004-2013 for women, who underwent mastectomy with or without IBR. Patients were grouped according to PMRT status. Multivariate logistic regression was used to calculate odds of IBR in the setting of PMRT. Trend analyses were done for rates and methods of IBR using Poisson regression to determine incidence rate ratios (IRR). Results In multivariate analysis, radiated patients were 30% less likely to receive IBR (p<0.05). The rate increase in IBR was greater in radiated compared to non-radiated patients (IRR: 1.12 vs. 1.09). Rates of reconstruction increased more so in radiated compared to non-radiated patients for both implants (IRR 1.15 vs. 1.11) and autologous techniques (IRR 1.08 vs. 1.06). Autologous reconstructions were more common in those receiving PMRT until 2005 (p<0.05), with no predominant technique thereafter. Conclusion Although IBR remains a relative contraindication, rates of IBR are increasing to a greater extent in patients receiving PMRT. Implants have surpassed autologous techniques as the most commonly used method of breast reconstruction in this setting.

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National trends and complication rates after bilateral mastectomy and immediate breast reconstruction from 2005 to 2012

Cited by 48 publications

References 16 publications

Incidence of complications following two‐stage expander/implant breast reconstruction: The impact of cancer diagnosis in prophylactic mastectomy

Incidence of complications following two‐stage expander/implant breast reconstruction: The impact of cancer diagnosis in prophylactic mastectomy

Does “Two is Better Than One” Apply to Surgeons? Comparing Single-Surgeon Versus Co-surgeon Bilateral Mastectomies

National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy

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