Trends in Post-Mastectomy Reconstruction in an Asian Population: A 12-Year Institutional Review

Ng, Yvonne Ying Ru; Tan, Veronique Kiak Mien; Goh, Terence; Yong, Wei Sean; Wong, Chow Yin; Madhukumar, Preetha; Ong, Kong Wee; Ong, Yee Siang; Sim, Yirong; Tan, Bien Keem; Tan, Benita Kiat Tee

doi:10.1111/tbj.12682

Cited by 16 publications

(9 citation statements)

References 36 publications

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“…Our study demonstrated that there was no delay of postoperative chemotherapy in the 92 patients who eventually received it ( Table 1). This is consistent with previous studies that investigated delays in adjuvant therapy due to IBR [28,29]. Frasier et al showed that recently increased use of PMRT in LABC was not associated with a decrease in IBR rate [30].…”

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confidence: 91%

Immediate Breast Reconstruction vs. Mastectomy Alone in Locally Advanced Breast Cancer; Local Recurrence and Distant Recurrence

et al. 2019

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Purpose: The oncologic safety of immediate breast reconstruction (IBR) has been demonstrated. However, the outcome of IBR for locally advanced breast cancer (LABC) is still under debate. We compared the survival outcome of LABC patients who underwent IBR vs. mastectomy alone. Methods: We retrospectively analyzed a total of 248 patients with stage III breast cancer who were treated with mastectomy between 2004 and 2015. The study subjects were divided into 2 groups: patients who received IBR (n= 77) or mastectomy alone (MA) (n= 171). We compared disease-free survival (DFS) of both groups. Results: Median follow-up duration was 49 months and the mean age of patients was 49 years. Patients in the IBR group were significantly younger and had lower body mass index (BMI) than those in the MA group. In a univariate analysis, IBR group showed better DFS than the MA group (DFS 81.3 months vs. 49.8 months, p< 0.001). There was no delay in adjuvant treatment in the IBR group. In a multivariate analysis, IBR was associated with better DFS (hazard ratio (HR) for recurrence: 0.37, 95% CI 0.20-0.69, p= 0.002) when adjusted for potential prognostic factors. In a subgroup analysis performed according to disease stage (IIIA and IIIB/IIIC), DFS was significantly better in IBR than MA group in both stage subgroups (p< 0.001). Conclusion: We demonstrated that patients who underwent IBR showed better DFS outcome compared with patients who underwent mastectomy alone. Our results can help surgeons to determine if IBR is an option in patients with LABC.

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confidence: 91%

Immediate Breast Reconstruction vs. Mastectomy Alone in Locally Advanced Breast Cancer; Local Recurrence and Distant Recurrence

et al. 2019

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“…There is an increasing desire for postmastectomy breast reconstruction in the Asian population, with autologous reconstruction accounting for 49% of the procedures [ 29 , 30 ]. To date, the DIEP flap is the most popular choice for autologous breast reconstruction [ 31 ].…”

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confidence: 99%

The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

et al. 2021

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Purpose The transverse musculocutaneous gracilis (TMG) flap is as a valuable alternative in autologous breast reconstruction. The purpose of this study was to evaluate the donor site morbidity and secondary refinement procedures after TMG flap breast reconstruction. Methods A retrospective study was conducted, including all patients who received TMG flap breast reconstructions, from January 2012 to August 2019. Primary outcomes were surgical site complications of the donor site and secondary refinement procedures carried out for aesthetic or reconstructive purposes for the medial thigh. Secondary outcomes of interest were lipofilling procedures for optimization of the reconstructed breasts. Results Ninety-nine patients received 159 TMG flaps for breast reconstruction. Patients’ mean BMI was 23.5 (15.6–32.5) kg/m2. Bilateral breast reconstructions were performed in 60.6%. The mean flap volume was 330 (231–440) g. Surgical site complications occurred in 14.5% of the TMG donor sites and wound dehiscence was the most common complication (9.4%). Lymphedema occurred in 1.8% of the donor thighs. Aesthetic refinement procedures were performed in 25.2% on the donor thigh or contralateral thigh. Secondary lipofilling was performed in 54.1% of the reconstructed breasts and fat was harvested in only 11.9% from the legs. Conclusion The TMG flap breast reconstruction combines low donor site morbidity with adequate volume for appealing breast results, particularly in slim-to-normal weight patients. However, patients should be informed about the likelihood of secondary refinement procedures on the donor site and the need of lipofilling to optimize the breast shape and volume.

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“…Among women in Singapore who chose to have a mastectomy, only 18 per cent underwent reconstruction after mastectomy. This again differs from the West and other parts of Asia, where reported rates of reconstruction after mastectomy are approximately 60 per cent .…”

Section: Introductionmentioning

confidence: 86%

Factors influencing patient decision-making between simple mastectomy and surgical alternatives

et al. 2018

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BackgroundDespite similar survival rates, breast‐conserving therapy (BCT) remains a distant second choice after simple mastectomy for patients with early‐stage breast cancer in Singapore. Uptake of reconstruction after mastectomy is also low (18 per cent). The aim of this study was to explore the factors influencing a patient's choice for mastectomy when eligible for BCT, and why patients decline reconstruction after mastectomy.MethodsPatients from the National Cancer Centre Singapore, who were eligible for BCT but chose mastectomy without reconstruction, between December 2014 and December 2015 were included. An interviewer‐administered questionnaire focusing on patients' reasons for choosing mastectomy over BCT and not opting for immediate breast reconstruction after mastectomy was used. Tumour characteristics were retrieved from medical records. Spearman's rank correlation coefficient, Mann–Whitney U and Kruskal–Wallis tests were used to analyse the correlation between the patient's self‐rated influential factors and variables. Statistical significance was taken as P < 0·050.ResultsNinety‐one patients were included (90·1 per cent response rate). The main reasons for choosing mastectomy over BCT were: fear of cancer recurrence (considered very important in 74 per cent), the perception that health outweighs breast retention (49 per cent) and the possibility of second surgery for margins (40 per cent). Key factors for rejecting immediate reconstruction after mastectomy were: patient‐perceived ‘old age’ (very important in 53 per cent), concern about two sites of surgery (42 per cent) and financial cost (29 per cent). Given a second chance, 19·8 per cent of patients would undergo BCT instead of mastectomy.ConclusionThis study has identified the considerations that women in Singapore have when deciding on breast cancer surgery. Some perceptions need to be addressed for women to make a fully informed decision, especially as one‐fifth regret their initial choice.

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Trends in Post-Mastectomy Reconstruction in an Asian Population: A 12-Year Institutional Review

Cited by 16 publications

References 36 publications

Immediate Breast Reconstruction vs. Mastectomy Alone in Locally Advanced Breast Cancer; Local Recurrence and Distant Recurrence

Immediate Breast Reconstruction vs. Mastectomy Alone in Locally Advanced Breast Cancer; Local Recurrence and Distant Recurrence

The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

Factors influencing patient decision-making between simple mastectomy and surgical alternatives

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