Breast Reconstruction: Outcomes Analysis

Michael J Bass, MD, JDwww.drmichaeljbass.com

Michael J Bass Plastic Surgery, PLLC

Disclosures

• None• Still need some

Analysis Factors

• What affects outcome– Neoadjuvant chemotherapy (Malata)– Radiation (Cordeiro)

• Overall Satisfaction– Unilateral versus bilateral reconstruction (Craft)

Neoadjuvant Chemotherapy and Immediate Breast Reconstruction

• 171 patients (198 breasts) by one surgeon– 64 free flaps, 74 pedicled

flaps, 60 implant based• 53 neoadjuvant, 118

controls• Neoadjuvant phase III

randomized trial

Malata, et al, Plastic and Reconstructive Surgery July 2010;126(1):1-11

Neoadjuvant Chemo (cont.)

Malata, et al, Plastic and Reconstructive Surgery July 2010;126(1):1-11

Neoadjuvant Chemo (cont.)

• Minor complications:– 6 (10%) neoadjuvant, 9 (6%) controls (p=.380)

• Major complications: – 1 (2%) neoadjuvant; 3 (2%) controls (p=1.0)

• No effect of neoadjuvant chemotherapy on risk of complications nor delay in adjuvant radiation

• Paper did not evaluate patient or surgeon satisfaction of reconstruction

Malata, et al, Plastic and Reconstructive Surgery July 2010;126(1):1-11

Radiation and Implant Based Reconstruction

• 143 patients with 1 year of follow up receiving immediate tissue expander reconstruction (1995-2001); no autologous reconstruction patients

• 68 patients with chest wall radiation (CWR) four weeks after placement of permanent prosthesis

• 75 control patients during same period

Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81

Radiation and Implants (cont.)

• Patients received 50 Gray in 25-28 fractions

• 6 MV to reconstructed breast, axillary apex, and supraclavicular region

• 68% of irradiated patients had grade II-IV capsular contracture; 40% control group (p=.006)

Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81

Radiation and Implants (cont.)• Doctors: 80% of irradiated

patients marked good-excellent; 88% for non-irradiated patients

• Patient satisfaction based upon self assessment questionnaire

• 67% irradiated, 88% non-irradiated patients satisfied (p=.004)

Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81

Radiation and Implants (cont.)

• No discussion on tumor grade or disease stage• 72% of irradiated patients and 85% of non-

irradiated patients would have again elected for tissue expander based reconstruction

Cordeiro, et al, Plastic and Reconstructive Surgery March 2004;113(3):877-81

Unilateral Versus Bilateral Reconstruction and Satisfaction

• 702 women (910 reconstructions) identified between 1999-2006

• 494 unilateral reconstructions, 416 bilateral reconstructions

Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24

Unilateral Versus Bilateral (cont.)

Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24

Unilateral Versus Bilateral (cont.)

• Patient surveys mailed• Minimum post reconstruction time 13

months, average of 56 months for unilateral and 49 months for bilateral patients

• Survey response: 75% unilateral, 79% bilateral

Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24

Unilateral Versus Bilateral (cont.) Reconstruction (cont.)

Craft, et al, Plastic and Reconstructive Surgery April 2011;127(4):1417-24

Barriers To Reconstruction• Doctor recommendation to seek counseling with a plastic

surgeon– 7/10 women eligible for reconstruction after a mastectomy are

not informed that the option exists (ASPS poll, 2009)• Logistical problem of coordinating consultations and

immediate reconstruction• Immediate reconstruction: 23.4% for invasive breast

cancer, 36.4% for DCIS• Medicaid kerfuffle quadrification in Kentucky• Age >50, rural living, black least likely to get reconstruction

Thank You For Coming

• Your participation in this lecture creates new opportunities for newly diagnosed women

• Breast cancer is far away from being treated with a pill