Oncological safety and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction

Patani, Neill; Devalia, Haresh; Anderson, A.; Mokbel, Kefah

doi:10.1016/j.suronc.2007.11.004

Cited by 70 publications

(65 citation statements)

References 35 publications

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“…In contrast to mastectomy, IBR has been shown to provide better cosmetic outcome and superior quality of life, without compromising oncological safety (2)(3)(4)(5)(6)(7)(9)(10)(11)(12)(13)(40)(41)(42)(43)(44).…”

Section: Discussionmentioning

confidence: 99%

“…In 2013 approximately 14,000 patients in the Netherlands were diagnosed with breast cancer, which is almost 30% of all cancer patients in the Netherlands (1). The cornerstone of breast cancer treatment is surgery in which mastectomy is still required, or the patients preferred option, in one third of all breast cancer patients (2,3). Breast reconstruction can be performed at the time of mastectomy, immediate breast reconstruction (IBR) using autologous tissue or implants (4).…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

et al. 2017

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Background: Immediate breast reconstruction (IBR) after mastectomy has shown to be oncologically safe and to improve quality of life in breast cancer patients. However, most women undergoing mastectomy do not undergo IBR. In this study, we aim to identify breast surgeon-related factors in considering IBR and factors affecting patients' decision to choose for IBR.Methods: Retrospective analysis of the records of breast cancer patients who underwent mastectomy with or without IBR between 2010 and 2013. We documented all information whether or not a patient underwent IBR after mastectomy.Results: Of 437 patients, 97 (22.2%) underwent IBR, 89.8% of which received tissue expanders. Patient who did not undergo IBR had a higher age (62.2 versus 51.9 years, P<0.001) and higher body mass index (BMI) (27.0 versus 24.3, P<0.001). Hundred three patients declined IBR, mainly because considering reconstruction as too much trouble. In 128 cases the breast surgeon did not offer IBR, mostly because of the predicted need for post mastectomy radiation. Approximately 11% of the patients were not informed about IBR.Conclusions: Anticipated radiation therapy, higher age and higher BMI were important breast surgeonrelated factors in refraining from IBR. Almost one third of all patients declined IBR. In almost 10% of all patients, IBR was not discussed.Keywords: Breast neoplasms; breast reconstruction; decision making; mammaplasty; mastectomy Submitted Aug 11, 2016. Accepted for publication Oct 27, 2016Oct 27, . doi: 10.21037/gs.2016 View this article at: http://dx.doi.org/10.21037/gs.2016.11.11 44 Weenk et al. Decision-making process in IBR © Gland Surgery. All rights reserved.Gland Surg 2017;6(1):43-48 gs.amegroups.com States. In 2000, 12.9% of all mastectomies performed in the United States were combined IBR, increasing to 36.3% in 2009 (15). The United Kingdom Association of Breast Surgery recommends that any patient in which IBR is oncologically safe should have the possibility to choose for IBR (16). Dutch guidelines state IBR has a slight preference instead of delayed reconstruction and that every patient considered for mastectomy has to be informed about reconstructive options (17). However, despite the evidence and recommendations, almost two thirds of the mastectomies are still performed without IBR. We asked ourselves if there are elements in the pre-operative process that could facilitate or impede the choice for IBR. The major objective of this study was to investigate the decision-making process on whether or not a patient undergoes immediate reconstruction after mastectomy. In this study we focused on the role of patient as well as the role of the breast surgeon. MethodsWe investigated all electronic patient files of women diagnosed with DCIS or invasive carcinoma between 2010 and 2013, and underwent a mastectomy at the Canisius Wilhelmina Breast Center in Nijmegen, the Netherlands. Patients who underwent prophylactic mastectomy were excluded. IBR is defined as mastectomy and reconstruction performed on the same day. ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

et al. 2017

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“…43 This has not been found in practice, and these concerns are no longer barriers to immediate reconstruction. 7,8,41,42 Box 1 presents a comparison of immediate and delayed reconstruction (any time after mastectomy) in terms of clinical and psychosocial advantages and disadvantages.…”

Section: What Is the Role Of Immediate Breast Reconstruction In The Tmentioning

confidence: 99%

“…There are many reconstructive methods available, using either autologous tissue or implants, 1 each with its unique set of indications, contraindications, advantages, disadvantages and complications (Table 1). Breast reconstruction after mastectomy is oncologically safe 7,8 and is associated with high satisfaction and improved psychosocial outcomes. 9 Although the rates of major complications after immediate reconstruction (at the same time as mastectomy) are greater than after mastectomy alone, clinically significant delays in the receipt of adjuvant therapy after immediate reconstruction have not been found.…”

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confidence: 99%

Breast reconstruction after mastectomy for breast cancer

Platt¹,

Baxter²,

Zhong³

2011

Canadian Medical Association Journal

100

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Review CMAJ• Breast reconstruction after mastectomy is an oncologically safe procedure that can improve psychosocial outcomes.• Increased age, nonwhite ethnic background, low income and nonurban residence are associated with decreased rates of breast reconstruction.• Physician perceptions and knowledge, as well as cancer stage, also influence the rate of this procedure.• Mastectomy with immediate breast reconstruction should be presented to patients with in situ or early stage breast cancer as an option along with breast-conservation therapy and mastectomy alone.

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“…Success can be defined as the best possible cosmetic result that does not sacrifice oncological safety [5,6]. In recent years, skin-sparing mastectomy (SSM) in combination with IBR has gained in acceptance and popularity for early invasive or in situ disease (DCIS) in terms of both oncological safety and acceptable rates of postoperative complications [7][8][9][10][11][12][13][14][15]. More recent reports have also documented the effectiveness of SSM plus IBR for locally advanced disease [16][17][18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study

Giacalone

Rathat

Daurès

et al. 2010

Breast Cancer Res Treat

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Feasibility and oncological safety of postadjuvant skin-sparing mastectomy (SSM) plus immediate breast reconstruction (IBR) cannot be evaluated by randomized trials. However, comparative study could modify guidelines for the oncosurgical treatment of invasive breast cancer. Our study compared the feasibility, oncological safety and esthetic outcome of SSM plus latissimus dorsi (LD) flap IBR after chemotherapy (CT) and radiotherapy (RT) with the standard management for invasive breast cancer: mastectomy as primary treatment, adjuvant CT and RT, and LD flap delayed breast reconstruction (DBR). Twenty-six selected patients with stages IIA-IIIA breast cancer were offered post-neoadjuvant SSM plus IBR with LD flap plus implant (IBR group). Seventy-eight other patients had primary mastectomy, adjuvant CT and RT, and LD-assisted DBR (DBR group). After 4.1 years (range 1-8) of follow-up, feasibility, oncological safety, and esthetic outcome were compared. Sixteen (61%) early complications were reported for the IBR group versus 44 (56%) for the DBR group (P = 0.645). Early implant loss was 0% in IBR versus 12% in DBR. IBR had 8 (30%) late complications versus 17 (21%) for DBR (P = 0.362). Capsular contracture and reconstruction failure rates were similar. Local recurrence was 7.7% (2/26) in IBR and 6.4% (5/78) in DBR (P = 0.823). Cosmetic evaluation by independent physicians and by the patients themselves was identical in the two groups. Our concept provides a basis for offering more women the opportunity to elect for immediate reconstruction, even in the setting of radiation therapy.

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Oncological safety and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction

Cited by 70 publications

References 35 publications

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

Breast reconstruction after mastectomy for breast cancer

New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study

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