Breast Reconstruction: Outcomes Analysis Michael J Bass, MD, JD Michael J Bass Plastic Surgery, PLLC.

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