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Reconstruction Patterns in a Single Institution Cohort of Women Undergoing Mastectomy for Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objectives

The purpose of the current study was to conduct a patient-centered investigation of reconstruction practices following mastectomy at our institution.

Methods

A questionnaire was administered to patients who underwent unilateral or bilateral mastectomy for breast cancer from 2006 to 2010. The survey queried on demographics, surgical choices, and rationale for those choices. Data were summarized by contingency tables and compared by chi-square test or Fisher’s exact test, as appropriate.

Results

Of 321 patients queried, 185 (58 %) underwent unilateral mastectomy and 136 (42 %) underwent bilateral mastectomy (mean age 56 ± 12 years). Overall, 189 (59 %) women underwent breast reconstruction, and 132 (41 %) did not. Immediate breast reconstruction was performed in 125 of 189 (69 %) women, whereas 67 of 189 (31 %) underwent delayed reconstruction. The method of definitive reconstruction included 143 of 189 (75 %) prostheses, 32 of 189 (17 %) abdominal tissue flap, 12 of 189 (6 %) latissimus flap (±implant), and 5 of 189 (2 %) with a combination of prostheses and tissue flaps. Of the 114 patients who did not undergo reconstruction, 68 (60 %) reported lack of desire for reconstruction as their motive, and the remaining 46 (40 %) reported medical contraindications for reconstruction or did not report a specific reason.

Conclusions

A significant percentage of women undergoing unilateral or bilateral mastectomy for breast cancer at our institution elect to undergo reconstruction. Prosthetic reconstruction was the most common method utilized. The impetus for referral to the reconstructive surgeon was nearly always initiated by the surgical oncologist.

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References

  1. Fisher B, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456–61.

    Article  PubMed  CAS  Google Scholar 

  2. Veronesi U, et al. Comparison of Halsted mastectomy with quandrantectomy, axillary dissection and radiotherapy in early breast cancer: long-term results. Eur J Cancer Clin Oncol. 1986;22(9):1085–9.

    Article  PubMed  CAS  Google Scholar 

  3. Bland K, et al. The National Cancer Data Base 10-year survey of breast carcinoma treatment at hospitals in the United States. Cancer. 1998;83(6):1262–73.

    Article  PubMed  CAS  Google Scholar 

  4. Gomez SL, et al. Increasing mastectomy rates for early-stage breast cancer? Population-based trends from California. J Clin Oncol. 2010;28(10):e155–7; author reply e158.

    Article  PubMed  Google Scholar 

  5. McGuire KP, et al. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol. 2009;16(10):2682–90.

    Article  PubMed  Google Scholar 

  6. Habermann E, et al. Are mastectomy rates really increasing in the United States? J Clin Oncol. 2010;28(21):3437–41.

    Article  PubMed  Google Scholar 

  7. Katipamula R, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effects of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27(25):4082–8.

    Article  PubMed  Google Scholar 

  8. Wilkins EG, et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2000;106(5):1014–25; discussion 1026–7.

    Article  PubMed  CAS  Google Scholar 

  9. Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer. 2000;36(15):1938–43.

    Article  PubMed  CAS  Google Scholar 

  10. Heneghan HM, et al. Quality of life after immediate breast reconstruction and skin-sparing mastectomy: a comparison with patients undergoing breast conserving surgery. Eur J Surg Oncol. 2011;37(11):937–43.

    Article  PubMed  CAS  Google Scholar 

  11. Wellisch DK, et al. Psychosocial correlates of immediate versus delayed reconstruction of the breast. Plast Reconstr Surg. 1985;76(5):713–8.

    Article  PubMed  CAS  Google Scholar 

  12. Yueh JH, et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg. 2010;125(6):1585–95.

    Article  PubMed  CAS  Google Scholar 

  13. Paulson R, Chang F, Helmer S. Kansas surgeons’ attitudes toward immediate breast reconstruction: a statewide survey. Am J Surg. 1994;168(6):543–6.

    Article  PubMed  CAS  Google Scholar 

  14. Allweis T, et al. Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapy. Am J Surg. 2002;183(3):218–21.

    Article  PubMed  Google Scholar 

  15. Eberlein T, et al. Prospective evaluation of immediate reconstruction after mastectomy. Ann Surg. 1993;218(1):29–36.

    Article  PubMed  CAS  Google Scholar 

  16. Gieni M, et al. Local breast cancer recurrence after mastectomy and immediate breast reconstruction for invasive cancer: a meta-analysis. Breast. 2012;21(3):230–6.

    Article  PubMed  CAS  Google Scholar 

  17. McCarthy CM, et al. Breast cancer recurrence following prosthetic, postmastectomy reconstruction: incidence, detection, and treatment. Plast Reconstr Surg. 2008;121(2):381–8.

    Article  PubMed  CAS  Google Scholar 

  18. Noguchi M, et al. Oncological aspect of immediate breast reconstruction in mastectomy patients. J Surg Oncol. 1992;50(4):241–6.

    Article  PubMed  CAS  Google Scholar 

  19. Reddy S, et al. Breast cancer recurrence following postmastectomy reconstruction compared to mastectomy with no reconstruction. Ann Plast Surg. 2011;66(5):466–71.

    Article  PubMed  CAS  Google Scholar 

  20. Morrow M, et al. Factors influencing the use of breast reconstruction postmastectomy: a National Cancer Database study. J Am Coll Surg. 2001;192(1):1–8.

    Article  PubMed  CAS  Google Scholar 

  21. Platt J, Baxter N, Zhong T. Breast reconstruction after mastectomy for breast cancer. CMAJ. 2011;183(18):2109–16.

    Article  PubMed  Google Scholar 

  22. Kruper L, et al. Disparities in reconstruction rates after mastectomy: patterns of care and factors associated with the use of breast reconstruction in Southern California. Ann Surg Oncol. 2011;18(8):2158–65.

    Article  PubMed  Google Scholar 

  23. Polednak AP. Postmastectomy breast reconstruction in Connecticut: trends and predictors. Plast Reconstr Surg. 1999;104:669–73.

    Article  PubMed  CAS  Google Scholar 

  24. Polednak AP. Geographic variation in postmastectomy breast reconstruction rates. Plast Reconstr Surg. 2000;106:298–301.

    Article  PubMed  CAS  Google Scholar 

  25. Alderman AK, et al. Correlates of referral practices of general surgeons to plastic surgeons for mastectomy reconstruction. Cancer. 2007;109(9):1715–20.

    Article  PubMed  Google Scholar 

  26. Reaby LL. Reasons why women who have mastectomy decide to have or not to have breast reconstruction. Plast Reconstr Surg. 1998;101(7):1810–8.

    Article  PubMed  CAS  Google Scholar 

  27. August D, Wilkins E, Rea T. Breast reconstruction in older women. Surgery. 1994;115(6):663–8.

    PubMed  CAS  Google Scholar 

  28. Bowman CC, et al. Breast reconstruction in older women: should age be an exclusion criterion? Plast Reconstr Surg. 2006;118:16–22.

    Article  PubMed  CAS  Google Scholar 

  29. Alderman AK, et al. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2002;109(7):2265–74.

    Article  PubMed  Google Scholar 

  30. Manganiello A, et al. Sexuality and quality of life of breast cancer patients post mastectomy. Eur J Oncol Nurs. 2011:167–72.

  31. Lee CN, Hultman CS, Sepucha K. What are patients’ goals and concerns about breast reconstruction after mastectomy? Ann Plast Surg. 2010;64(5):567–9.

    PubMed  CAS  Google Scholar 

  32. Evans GR, et al. Reconstruction and the radiated breast: is there a role for implants? Plast Reconstr Surg. 1995;96(5):1111–5; discussion 1116–8.

    Article  PubMed  CAS  Google Scholar 

  33. Ascherman JA, et al. Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg. 2006;117(2):359–65.

    Article  PubMed  CAS  Google Scholar 

  34. Schuster RH, et al. Breast reconstruction in women treated with radiation therapy for breast cancer: cosmesis, complications, and tumor control. Plast Reconstr Surg. 1992;90(3):445–52; discussion 453–4.

    Article  PubMed  CAS  Google Scholar 

  35. Kronowitz SJ, Robb GL. Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg. 2009;124(2):395–408.

    Article  PubMed  CAS  Google Scholar 

  36. Williams J, et al. TRAM flap breast reconstruction after radiation treatment. Ann Surg. 1995;221(6):756–66.

    Article  PubMed  CAS  Google Scholar 

  37. Hunt KK, et al. Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction. Ann Surg Oncol. 1997;4(5):377–84.

    Article  PubMed  CAS  Google Scholar 

  38. Tran NV, et al. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg. 2001;108(1):78–82.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Leisha Elmore BS, Terence M. Myckatyn MD, Jordan Atkins BS, Tonya M. Martin-Dunlap MD & Julie A. Margenthaler MD, FACS

  2. Department of Surgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Feng Gao PhD

  3. Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA

    Carla S. Fisher MD

Authors
  1. Leisha Elmore BS
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  2. Terence M. Myckatyn MD
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  3. Feng Gao PhD
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  4. Carla S. Fisher MD
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  5. Jordan Atkins BS
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  6. Tonya M. Martin-Dunlap MD
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  7. Julie A. Margenthaler MD, FACS
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Corresponding author

Correspondence to Julie A. Margenthaler MD, FACS.

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Elmore, L., Myckatyn, T.M., Gao, F. et al. Reconstruction Patterns in a Single Institution Cohort of Women Undergoing Mastectomy for Breast Cancer. Ann Surg Oncol 19, 3223–3229 (2012). https://doi.org/10.1245/s10434-012-2530-0

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  • DOI: https://doi.org/10.1245/s10434-012-2530-0

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