Breast Reconstruction In Women Research Articles

Complications After Prepectoral Versus Subpectoral Breast Reconstruction in Patients Receiving Postmastectomy Radiation Therapy: A Systematic Review and Meta-Analysis.

Outcomes of immediate breast reconstructions can be influenced by postoperative radiotherapy. However, there is no clarity on the use of prepectoral or subpectoral breast reconstruction in the setting of postmastectomy radiation therapy (PMRT). We reviewed evidence on the complication rates of prepectoral and subpectoral breast reconstruction in women undergoing PMRT. PubMed, Web of Science, and Embase databases were scanned for studies comparing complication rates of prepectoral and subpectoral breast reconstruction with PMRT. All complications were pooled in a random-effect meta-analysis to obtain odds ratio (OR). Eight observational studies were included. Meta-analysis showed no difference in the risk of infections (OR: 1.22 95% CI 0.79, 1.88 I2=0%), implant loss (OR: 0.86 95% CI 0.50, 1.50 I2=14%), seroma (OR: 1.01 95% CI 0.43, 2.34 I2=50%), hematoma (OR: 0.44 95% CI 0.12, 1.71 I2=0%), wound dehiscence (OR: 0.95 95% CI 0.42, 2.17 I2=0%), and skin necrosis (OR: 0.61 95% CI 0.21, 1.75 I2=36%), contracture (OR: 0.46 95% CI 0.15, 1.48 I2=54%) and the need for revision surgeries (OR: 0.85 95% CI 0.45, 1.60 I2=15%) between the prepectoral and subpectoral groups. Data from observational studies indicates that in appropriately selected patients there may not be any difference in the risk of early complications with prepectoral or subpectoral breast reconstruction with PMRT. Current evidence is limited by the small number of studies, short follow-up and selection bias. There is a need for randomized controlled trials comparing the two approaches to obtain robust evidence on long-term outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Oncological status is not a determinant of refraining from breast reconstruction among 490 candidates for mastectomy and post-mastectomy radiotherapy

Although breast reconstruction in the setting of post-mastectomy radiotherapy (PMRT) is controversial, we offer nipple-sparing mastectomy and immediate implant-based breast reconstruction ([N]SSM/IIBR) to women needing primary mastectomy regardless of PMRT. Nevertheless, some of these women have no reconstruction. To assess the uptake of breast reconstruction in women who undergo PMRT and the patient characteristics associated with such uptake. Additionally, we assessed the determinants of forgoing breast reconstruction. Demographic, physical and oncological characteristics of women who underwent mastectomy, PMRT and breast reconstruction were compared to the characteristics of those who did not undergo breast reconstruction from 2013 through 2018. As determinants of delaying or refraining from breast reconstruction, we distinguished between an oncological reason, patient's preference, patient's co-morbidity, combined tobacco abuse and obesity and the need for PMRT. 490 women received PMRT. Of these, 396 women (81%) underwent combined [N]SSM/IIBR and PMRT or mastectomy and PMRT with delayed breast reconstruction. Ninety-four additional women (19%) did not undergo breast reconstruction. The latter group differed significantly from those who did in demographic and physical characteristics but not in terms of oncological diagnosis and history. Patient's preference was the single most frequent determinant of not performing either immediate or delayed breast reconstruction among these 94 women. Oncological status was not a major determinant in refraining from reconstruction. The significant difference in non-oncological characteristics between the reconstructed and non-reconstructed women confirms the importance of these characteristics in the preference for either reconstruction or non-reconstruction.

Secondary healthcare costs after mastectomy and immediate breast reconstruction for women with breast cancer in England: a population-based cohort study.

Immediate breast reconstruction after mastectomy can improve the quality of life for women with breast cancer and rates are increasing. Long-term inpatient costs of care were estimated to understand the impact of different immediate breast reconstruction procedures on healthcare expenditure. Hospital Episode Statistics Admitted Patient Care data were used to identify women undergoing unilateral mastectomy and immediate breast reconstruction in English National Health Service hospitals (1 April 2009 to 31 March 2015) and any subsequent procedures performed to revise, replace, or complete the breast reconstruction. Costs were assigned to Hospital Episode Statistics Admitted Patient Care data using the Healthcare Resource Group 2020/21 National Costs Grouper. Generalized linear models were used to estimate mean cumulative costs for five immediate breast reconstruction procedures over 3 and 8 years, adjusting for covariates (age/ethnicity/deprivation). A total of 16 890 women underwent mastectomy and immediate breast reconstruction: implant (5192; 30.7 per cent), expander (2826; 16.7 per cent), autologous latissimus dorsi flap (2372; 14.0 per cent), latissimus dorsi flap with expander/implant (3109; 18.4 per cent), and abdominal free-flap reconstruction (3391; 20.1 per cent). The mean (95 per cent c.i.) cumulative cost was lowest for latissimus dorsi flap with expander/implant reconstruction (€20 103 (€19 582 to €20 625)) over 3 years and highest for abdominal free-flap reconstruction (€27 560 (€27 037 to €28 083)). Over 8 years, expander (€29 140 (€27 659 to €30 621)) and latissimus dorsi flap with expander/implant (€29 312 (€27 622 to €31 003)) reconstructions were the least expensive, while abdominal free-flap reconstruction (€34 536 (€32 958 to €36 113)) remained the most expensive, despite having lower costs for revisions and secondary reconstructions. This was driven primarily by the cost of the index procedure (€5435 (expander reconstruction) to €15 106 (abdominal free-flap reconstruction)). Hospital Episode Statistics Admitted Patient Care Healthcare Resource Group data provided a comprehensive longitudinal cost assessment of secondary care. Although abdominal free-flap reconstruction was the most expensive option, higher costs of the index procedure need to be balanced against ongoing long-term costs of revisions/secondary reconstructions, which are higher after implant-based procedures.

Abstract P2-15-02: Omentum-Lipoaspirate Free-Flap Breast Reconstruction in Women with BMI <25

Abstract The Omental Fat-Augmented Free-flap (O-FAFF) is being offered at our institution as an alternative method of breast reconstruction. This novel free-flap construct is ideal for underweight and normal weight women who lack abdominal or other donor tissue, desire to avoid donor site morbidity and/or are averse to implant-based reconstruction. We analyze omentum, mastectomy and final construct weights in women with BMI < 25 kg/m2 who underwent nipple-sparing mastectomies and O-FAFF reconstruction. Methods Operative technical features of women undergoing nipple-sparing mastectomies with immediate O-FAFF breast reconstruction over a 34 month period are included. Steps of the operative procedure are as follows: laparascopic omentectomy, liposuction and unilateral or bilateral mastectomy is performed. An acellular dermal matrix (ADM) shell is fashioned around a tissue expander. This mold is filled with the omentum and then engrafted with lipoaspirate followed by microsurgical anastomoses of gastroepiploic artery and vein to internal mammary artery and vein. Weight of biological construct is compared to native breast weight. Results 26 women with average BMI 21.2 kg/m2 underwent unilateral (15) or bilateral (11) nipple-sparing mastectomies and O-FAFF reconstruction. Average omentum weight for 37 breasts was 149 gm (82- 262) and average mastectomy weighed 212.4 gm (85 – 396). The ratio of engrafted fat to omentum weight was 0.73 for unilateral versus 0.91 for bilateral cases. The ratio of omentum-fat graft construct to mastectomy weight was 1.24 for unilateral and 0.96 for bilateral cases. Conclusion O-FAFF is a novel procedure for autologous tissue breast reconstruction after nipple-sparing mastectomy in underweight and normal weight women. Comparable weight replacement for extirpated native breast is achieved. Citation Format: Irene L. Wapnir, Monica M. Dua, Yulia Zak, Dung Nguyen. Omentum-Lipoaspirate Free-Flap Breast Reconstruction in Women with BMI <25 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-15-02.

Quality of Life in Breast Reconstruction Patients after Irradiation to Tissue Expander: A Propensity-Matched Preliminary Analysis.

Tissue expanders (TEs) are routinely placed as a first step in breast reconstruction for women who require postmastectomy radiation therapy (PMRT). The final reconstruction can then be performed with implants or conversion to autologous tissues. The purpose of this study was to compare patient-reported outcomes and surgical complications in autologous (ABR) versus implant-based breast reconstruction (IBR) patients following TE-PMRT. The authors performed a propensity score preliminary analysis (1:1 matching, no replacement) in patients undergoing ABR or IBR following TE-PMRT. Matched covariates included age, race/ethnicity, smoking status, body mass index, history of psychiatric diagnosis, and laterality of reconstruction. Outcomes of interest included complications and BREAST-Q scores for Satisfaction with Breasts, Physical Well-Being of the Chest, Sexual Well-Being, and Psychosocial Well-Being domains. Of 341 patients with TE-PMRT, a total of 106 patients were included in the matched analysis: 53 ABR patients and 53 IBR patients. ABR and IBR did not differ significantly in matched baseline, cancer, and surgical characteristics. ABR patients had higher scores for Satisfaction with Breasts (greater than the four-point minimal clinically important difference) at all postreconstruction time points compared with IBR patients ( P < 0.05). There were no significant postoperative differences in other BREAST-Q domains. The incidence of complications after definitive reconstruction did not differ significantly among cohorts. In this matched preliminary analysis, patients who underwent ABR following irradiation to a TE demonstrated superior satisfaction with breast scores compared with IBR patients. Higher powered matched studies are needed to improve shared decision-making for patients who require mastectomy and PMRT as part of their treatment. Therapeutic, III.

Surgical Delay of Nipple Areola Complex: A Powerful Technique to Extend the Indication of Nipple-Sparing Mastectomy

BackgroundSurgical delay (SD) techniques, performed before the nipple sparing mastectomy (NSM), are procedures conceived to improve the blood supply to the nipple-areola complex (NAC) in order to overcome the ischemic risk. The aim of the study is reporting our experience with SD of the NAC in the setting of NSM, identify the rate of nipple and skin necrosis and other complications and to evaluate patient satisfaction with cosmetic outcome. Patients and MethodsA retrospective review of female patients, who underwent NSM and breast reconstruction between the July 2014 and the July 2019, was performed at the Breast Unit of San Giovanni-Addolorata Hospital in Rome. Eighty-nine NSM after SD procedure were performed in 66 patients. In all cases immediate breast reconstruction was performed with a direct to implant technique and polyurethane implants in prepectoral plan were used in all reconstructions. ResultsWe registered only 1 case of total NAC necrosis and 3 skin flap necrosis. Furthermore, patient satisfaction with breast reconstruction resulted excellent or good in 23 cases and good in 36 cases; the external plastic surgeon considered the breast reconstruction excellent or good in 63 cases. ConclusionWe support the thesis that SD techniques may expand indications for NAC sparing mastectomy and immediate breast reconstruction in women with known risk factors for local complications.MicroabstractThis is the largest single center series on surgical delay of nipple areola complex providing interesting data on follow-up and complication rates and we support the thesis that surgical delay techniques may expand indications for nipple-areola complex sparing mastectomy and immediate breast reconstruction in women with known risk factors for local complications.

61 (PB-061) Poster - Short-term surgical complications of skin-sparing mastectomy and direct-to-implant immediate breast reconstruction in women concurrently treated with adjuvant radiotherapy for breast cancer (2022; archives of plastic surgery (aps))

Background: Postmastectomy radiotherapy (PMRT) is allegedly associated with a higher risk of complications of combined nipple-sparing or skin-sparing mastectomy and subpectoral direct-to-implant immediate breast reconstruction ([N]SSM/SDTI-IBR). For this reason, this combination is usually advised against or, even, refused in women who need to undergo PMRT. Because this advice has never been justified, we assessed the short-term complications that may potentially be associated with PMRT after [N]SSM/SDTI-IBR.

Short-Term Surgical Complications of Skin-Sparing Mastectomy and Direct-to-Implant Immediate Breast Reconstruction in Women Concurrently Treated with Adjuvant Radiotherapy for Breast Cancer.

Background Postmastectomy radiotherapy (PMRT) is allegedly associated with a higher risk of complications of combined nipple-sparing or skin-sparing mastectomy and subpectoral direct-to-implant immediate breast reconstruction ([N]SSM/SDTI-IBR). For this reason, this combination is usually advised against or, even, refused in women who need to undergo PMRT. Because this advice has never been justified, we assessed the short-term complications that may potentially be associated with PMRT after [N]SSM/SDTI-IBR. Methods We compared the complications requiring reintervention and implant loss occurring after 273 [N]SSM/SDTI-IBR that were exposed to PMRT within the first 16 postoperative weeks (interventional group) to those occurring in 739 similarly operated breasts that were not (control group). Additionally, we compared the fraction of complications requiring reintervention occurring after the onset of radiotherapy in the interventional group to that occurring after a comparable postoperative period in the control group. Results The fraction of breasts requiring unscheduled surgical reinterventions for complications and the loss of implants did not differ significantly between both groups but significantly more reinterventions were needed among the controls ( p = 0.00). The fraction of events after the onset of radiotherapy in the interventional group was higher than the fraction of events after 6.2 weeks in the control group, but not significantly so. Conclusion We found no prove for the alleged increase of short-term complications of adjuvant radiotherapy. Therefore, we advise that these should not be considered valid arguments to advice against [N]SSM/SDTI-IBR.

Comparison of nine methods of immediate breast reconstruction after resection of localized breast cancer: A cost‐effectiveness Markov decision analysis of prospective studies

Women undergoing immediate breast reconstruction without radiation therapy have reconstruction methods available with uncertain long-term costs associated with complications requiring surgery and revisions. We evaluated cost-effectiveness of nine methods of immediate breast reconstruction for women with localized breast cancer. Markov modeling was performed over 10-years for unilateral/bilateral breast reconstructions from healthcare/societal perspectives. PubMed, Embase, Cochrane, Scopus, and CINAHL were searched to derive data from 13,744 patients in 79 prospective studies. Complications requiring surgery (mastectomy necrosis, total/partial flap necrosis, seroma, hematoma, infection, wound dehiscence, abdominal hernia, implant removal/explantation) and revisions (fat necrosis, capsular contracture, asymmetry, scars/redundant tissue, implant rupture/removal, fat grafting) were evaluated over yearly cycles. Reconstructions included: direct-to-implant (DTI), tissue expander-to-implant (TEI), latissimus dorsi flap-to-implant (LDI), latissimus dorsi (LD), pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, deep inferior epigastric perforator/superficial inferior epigastric artery (DIEP/SIEA), thigh-based, or gluteal based flaps. Outcomes were incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB). Willingness-to-pay thresholds were $50,000 and $100,000. From a healthcare perspective for unilateral reconstruction, compared to LD, the ICER for DTI was -$42,109.35/quality-adjusted life-years (QALY), LDI was -$25,300.83/QALY, TEI was -$22,036.02/QALY, DIEP/SIEA was $8307.65/QALY, free TRAM was $8677.26/QALY, pedicled TRAM was $13,021.44/QALY, gluteal-based was $17,698.99/QALY, and thigh-based was $23,447.82/QALY. NMB of DIEP/SIEA was $404,523.47, free TRAM was $403,821.40, gluteal-based was $392,478.64, thigh-based was $387,691.70, pedicled TRAM was $376,901.83, LD was $370,646.93, DTI was $339,668.77, LDI was $334,350.30, and TEI was $329,265.84. All nine methods of immediate breast reconstruction were considered cost-effective from healthcare/societal perspectives. LD provided the lowest costs, while DIEP/SIEA provided the greatest effectiveness and NMB.

Breast Implant Associated Lymphoma: Textured Breast Implants and Their Association with Cancer

Breast implants are one of the most popular medical devices used today. It has been estimated that at least 10 million women globally have had implants [1]. The most common use of breast implants is for cosmetic breast augmentation [2]. Implants are also often used in breast reconstruction for women who have had mastectomies. A less common use for implants is in gender-affirming surgery for transgender women. The first modern implant, consisting of a smooth-surfaced silicone outer shell filled with silicone gel, was introduced to the public in 1961, while saline-filled implants were introduced in 1965 [3]. The first textured implant was introduced in the late 1980s.

Breast conserving surgery with immediate partial breast reconstruction using a latissimus dorsi mini flap: oncological clearance and cosmetic outcomes

Background: In our center, a breast conserving surgery (BCS) with immediate partial breast reconstruction using a latissimus dorsi mini flap (LDMF) is performed in women with a large tumor-to-breast-size ratio who declined mastectomy. We conducted a study to assess the oncological clearance and cosmetic outcomes following a BCS with immediate LDMF partial breast reconstruction in women with various breast pathologies. Methods: A cross-sectional study was conducted involving patients who underwent a BCS with immediate LDMF reconstruction between January 2016 and January 2021 in the hospital Kuala Lumpur, Malaysia. The demographic data, tumor characteristics, operative details and post-operative complications were documented. The histopathological reports were reviewed to determine the oncological clearance. Patient’s satisfaction on the cosmetic outcomes evaluated using a standard breast-Q questionnaire.Results: Thirty patients with various breast pathologies were recruited; invasive carcinoma (n=26, 86.7%), ductal carcinoma in-situ (DCIS) (n=1, 3.3%), phyllodes tumor (n=2, 6.7%), and dermatofibrosarcoma protuberans (n=1, 3.3%). The mean tumor size was 4.92 cm, giving the mean specimen weight of 224 g. Adequate oncological clearance was obtained in 96.7% of all cases. Seventeen of the patients (n=17, 56.6 %) were deeply satisfied and the remaining patients were satisfied (n=13, 43.3 %).Conclusions: In a stage II/III breast cancer, a BCS with immediate partial breast reconstruction using a LDMF can be safely performed with satisfactory cosmetic outcomes in women with a large tumor-to-breast-size ratio.

Does the Duration of Perioperative Antibiotic Prophylaxis Influence the Incidence of Postoperative Surgical-Site Infections in Implant-Based Breast Reconstruction in Women with Breast Cancer? A Retrospective Study.

Perioperative antibiotic prophylaxis is an established concept to reduce the risk of surgical-site infections; however, the optimal treatment duration in prosthetic breast reconstruction is still controversial. This study evaluated a potential association between the perioperative antibiotic prophylaxis duration (≤24 hours versus >24 hours) and incidence of postoperative surgical-site infections in immediate implant-based breast reconstruction in breast cancer patients. A descriptive, retrospective analysis of surgical-site infections after immediate implant-based breast reconstruction in breast cancer patients between January of 2011 and December of 2018 was performed. The incidence of postoperative surgical-site infections in patients with more than 24 hours of perioperative antibiotic prophylaxis was compared to patients treated for 24 hours or less. A total of 240 patients who met criteria were included. There were no relevant epidemiologic, clinical, or histopathologic differences between groups. Surgical-site infections as defined by the Centers for Disease Control and Prevention criteria occurred in 25.8 percent. A risk factor-adjusted analysis by a prespecified multiple logistic regression model showed that 24 hours or less of perioperative antibiotic prophylaxis was not inferior to treatment for more than 24 hours. The upper limit of the one-sided 95 percent confidence interval of the risk difference was 9.4 percent (below the prespecified noninferiority margin of 10 percent leading to statistical significance). Risk factors for a surgical-site infection included obesity and postoperative wound complications. The study found no association between short-course perioperative antibiotic prophylaxis (≤24 hours) and an increased rate of postoperative surgical-site infection. This is of high clinical relevance because short-course treatment can help reduce side effects and the emergence of antimicrobial resistance and prevent surgical-site infections as effectively as a prolonged perioperative antibiotic prophylaxis course. Therapeutic, III.

"Struggling to Accept the New Breast as Part of My Body" - The Challenge of Immediate Breast Reconstruction in Women With Breast Cancer.

Women have difficulties in making decisions and experiences an unexpectedly long recovery period after immediate breast reconstruction. There are still many limitations in understanding the overall changes in life experienced by women with breast cancer before and after immediate breast reconstruction. This study aimed to explore the challenges experienced by women with breast cancer undergoing immediate breast reconstruction and how they coped with these problems. Strauss and Corbin's grounded theory design was used. In-depth face-to-face individual interviews were undertaken with 11 women with breast cancer from 4 hospitals in Korea. Data collection and analysis were conducted simultaneously, using the constant comparative method. The core category was "struggling to accept the new breast as part of my body." "Decision making regarding immediate breast reconstruction" was the initial step, followed by "facing the changed breasts after surgery." The challenge of "living with the new breasts" slowly merged into "making up my mind to accept my breasts with gratitude." Women with breast cancer undergoing immediate breast reconstruction struggled to accept the new breast as part of their body, and some reached a measure of closure and acceptance with gratitude. Nurses can apply findings by recognizing the experiences, perceptions, and needs of women; providing patients with sufficient information on the whole process; and offering continuous supportive care to facilitate the coping process. In addition, nurses should consider a variety of approaches that help women to integrate their changed bodies into their self-concept and self-image and restore a sense of normality.

Cost-effectiveness of Nine Methods of Immediate Breast Reconstruction for Women with Localized Breast Cancer Not Receiving Radiation Therapy: A Markov/Monte Carlo Analysis

Cost-effectiveness of Nine Methods of Immediate Breast Reconstruction for Women with Localized Breast Cancer Not Receiving Radiation Therapy: A Markov/Monte Carlo Analysis

Inferior gluteal artery perforator (IGAP) flap versus profunda artery perforator (PAP) flap as an alternative option for free autologous breast reconstruction

When patients are unsuitable for deep inferior epigastric perforator (DIEP) flap breast reconstruction, the inferior gluteal artery perforator (IGAP) flap has been used as an alternative option. However, the profunda artery perforator (PAP) flap is also gaining popularity as an alternative to the DIEP flap for several reasons. This retrospective cohort study compares baseline characteristics, peri- and post-operative outcomes following IGAP flap and PAP flap breast reconstructions after mastectomy for cancer. In a single center in the UK, from September 2008 through December 2016, 43 women underwent IGAP Flap(s) breast reconstruction and 51 received PAP flap(s) breast reconstructions. Statistical analysis was performed to compare baseline, peri-operative and post-operative variables between the two reconstruction methods. Perioperative complications requiring reoperation were experienced in women undergoing IGAP flap breast reconstructions only (21% versus 0%, p=0.001), principally due to the risk of total flap failure (12% versus 0%, p=0.01). Women undergoing IGAP flap breast reconstructions were at significantly higher odds of revision surgery (OR 17 [95% CI: 5.5-53], p<0.001), which was unchanged after adjusting for bilateral reconstructions (adjusted OR 18 [95% CI: 5.3-58], p<0.001). PAP flaps appear to be associated with significantly fewer complications and revision surgeries than IGAP flaps for breast reconstruction in women undergoing mastectomy for cancer and who are unsuitable for a DIEP flap breast reconstruction.

1042 The Effect of Breast Reconstruction Type on Complication Rates and Patient Satisfaction in The Setting of Postmastectomy Radiotherapy (PMRT)

Abstract Introduction The National Institute for Health and Care Excellence recommend offering post mastectomy radiotherapy (PMRT) to people with involved resection margins. With increasing evidence supporting the effectiveness of PMRT, it is important to optimise the outcomes of breast reconstruction in women receiving PMRT. Method A search was conducted in the PubMed database. The exclusion criteria were patients undergoing neoadjuvant radiotherapy and patients with metastases. The primary outcomes were patient satisfaction and complication rates. Results A meta-analysis (N = 380) found prosthetic reconstructions were 5 times more likely to develop complications than autologous reconstructions in the setting of PMRT (OR = 0.20, 95% CI = 0.1-0.4). A systematic review (N = 5437) had higher rates of total complications in prosthetic reconstructions compared to autologous reconstructions (41.3% vs 30.9%) with PMRT. Similarly, a retrospective study of PMRT patients (N = 622) had higher rates of complications with prosthetic reconstructions compared to autologous reconstructions (OR = 0.47, 95% CI = 0.27-0.82, P = 0.007). The adjusted mean satisfaction score (AMSS) of patients with autologous and prosthetic reconstructions receiving PMRT in a study (N = 54) was 4.4 and 2.8, respectively. Patient-reported satisfaction in a study (N = 622) was higher in patients with autologous (AMSS=63.5, 95% CI = 55.9-71.1) compared to prosthetic reconstructions (AMSS=47.7, 95% CI = 40.2-55.2) (all P = 0.002) with PMRT. Conclusions Existing data suggests that autologous tissue reconstructions tend to be more compatible with PMRT than prosthetic reconstructions in terms of patient satisfaction and complication rates. Although more research is needed to support these findings, current data can help patients and physicians make informed decisions regarding the type of breast reconstruction to use with PMRT.

Breast reconstruction is a viable option for older patients.

Breast cancer is diagnosed at a median age of 62years in the USA. At the same time, mortality rates for breast cancer continue to decrease, falling by 40% from 1989 to 2016. In the coming decades, the number of elderly patients with breast cancer, potentially seeking reconstruction, is expected to increase. A retrospective chart review of 309 patients, aged 60years or older, undergoing immediate or delayed breast reconstruction, was conducted. Patient characteristics, clinical information and major complications requiring reoperation were evaluated. Multivariate analyses identified factors contributing to complications such as BMI, comorbidities, smoking status, history of previous breast conservation therapy (BCT), total expander volume, radiotherapy, and chemotherapy. 26.7% of patients had at least one complication requiring reoperation, and 6.9% of patients suffered reconstructive failure. Logistic regression analysis of all patients (n = 309) found a statistically significant relationship between major complication and history of ipsilateral BCT (p = 0.026) and adjuvant chemotherapy (p = 0.005). Logistic regression analysis in patients undergoing tissue expander (TE) reconstruction (n = 215) showed that major complications were related to BMI over 35kg/m2 (p = 0.04), history of ipsilateral BCT (p = 0.048), and adjuvant chemotherapy (p = 0.033). Breast reconstruction in women over 60years old was not independently associated with higher major complication rates in our series.

A Safe Alternative for Breast Reconstruction in Women with Macromastia: The Goldilocks Technique

A Safe Alternative for Breast Reconstruction in Women with Macromastia: The Goldilocks Technique

Deep inferior epigastric perforator free flap in elderly women for breast reconstruction: The experience of a tertiary referral center and a literature review.

A general belief is to consider elderly patients as poor candidates for free flap reconstruction, which does not reflect our 20-year experience for breast reconstruction (BR). The aim of this study was to determine the safety and benefits of BR using deep inferior epigastric perforator (DIEP) free flap in the elderly population. We conducted a retrospective study of all consecutive BRs using DIEP flaps in patients 65years or older at the European Georges Pompidou Hospital from January2011 to December2019. Postoperative complications were reported as minor or major. We used a descriptive approach to analyze the main characteristics of the patients included. Surgical patient-reported outcomes and quality of life were assessed using the validated BREAST-Q questionnaire. Eighty-three DIEP flaps were performed in 79patients (4bilateral flaps) for BR. Sixty-six percent of the patients (52/79) did not present any complication. Total flap loss occurred in 3BR (3.6%), arterial thrombosis in 4BR (4.8%), and venous thrombosis in 8BR (9.6%). The average duration of inpatient stay was 9.5 (±2.7) days. Forty-one of 69eligible patients completed the questionnaire (response rate 59.4%). Patients reported high satisfaction and well-being scores. The mean Q score for psychosocial well-being was 75.4 (±16.7) and 59 (±13.3) for satisfaction with breasts. In our retrospective cohort, DIEP flap BR in elderly population had similar success and complication rates compared with those in younger patients, as well as high satisfaction scores. The free flap should be encouraged for BR in women over 65years of age, and personal motivation as well as physiologicalage considered as main criteria for patient selection.

Implementing an Electronic Clinical Decision Support Tool Into Routine Care: A Qualitative Study of Stakeholders' Perceptions of a Post-Mastectomy Breast Reconstruction Tool.

Objective. To explore barriers and facilitators to implementing an evidence-based clinical decision support (CDS) tool (BREASTChoice) about post-mastectomy breast reconstruction into routine care. Materials and Methods. A stakeholder advisory group of cancer survivors, clinicians who discuss and/or perform breast reconstruction in women with cancer, and informatics professionals helped design and review the interview guide. Based on the Consolidated Framework for Implementation Research (CFIR), we conducted qualitative semistructured interviews with key stakeholders (patients, clinicians, informatics professionals) to explore intervention, setting characteristics, and process-level variables that can impact implementation. Interviews were transcribed, coded, and analyzed based on the CFIR framework using both inductive and deductive methods. Results. Fifty-seven potential participants were contacted; 49 (85.9%) were eligible, and 35 (71.4%) were enrolled, continuing until thematic saturation was reached. Participants consisted of 13 patients, 13 clinicians, and 9 informatics professionals. Stakeholders thought that BREASTChoice was useful and provided patients with an evidence-based source of information about post-mastectomy breast reconstruction, including their personalized risks. They felt that BREASTChoice could support shared decision making, improve workflow, and possibly save consultation time, but were uncertain about the best time to deliver BREASTChoice to patients. Some worried about cost, data availability, and security of integrating the tool into an electronic health record. Most acknowledged the importance of showing clinical utility to gain institutional buy-in and encourage routine adoption. Discussion and Conclusion. Stakeholders felt that BREASTChoice could support shared decision making, improve workflow, and reduce consultation time. Addressing key questions such as cost, data integration, and timing of delivering BREASTChoice could build institutional buy-in for CDS implementation. Results can guide future CDS implementation studies.