Mastectomy Reconstruction Research Articles

Unveiling perceptions regarding post mastectomy breast reconstruction: A questionnaire-based survey of patients from central India.

Post mastectomy breast reconstruction uptake remains low in the developing countries. We examined patient perspectives about it in a cohort of Indian breast cancer patients. This prospective study was conducted at a tertiary care center in central India. All post mastectomy patients for breast cancer were interviewed via a survey questionnaire to assess their perspective regarding post mastectomy breast reconstruction. None of the 192 patients underwent immediate or delayed reconstruction by the end of 24months follow-up. Age, education level, occupation and marital status did not affect the uptake of post mastectomy breast reconstruction. The most common patient-reported reasons for not having reconstruction were the desire to avoid additional surgery and the belief that it was not important (80% for each). System related factors such as additional cost of surgery and additional length of stay were reported to be important by 55% and 65% patients respectively. Our survey of 192 post mastectomy breast cancer patients showed that none opted for post mastectomy reconstruction, suggesting significant barriers to it. Understanding and addressing these barriers are crucial to ensuring comprehensive care for these breast cancer patients.

Reliability of YouTube content targeting Arabic-speaking patients with breast cancer regarding post-mastectomy reconstruction.

e13626 Background: The dynamic and easily accessible nature of social media platforms, particularly YouTube (YT), has revolutionized the way breast cancer (BC) patients seek and process information. This study aims to evaluate the quality of YT videos addressing post-mastectomy reconstruction (PMR) that target Arabic-speaking women (ASW), a heavily digitally connected segment of society that may experience challenges in accessing mainstream medical information in Arabic Language (AL). Methods: YT was searched incognito, using the terms: "post mastectomy reconstruction" in (AL) in July 2023. Upload date, video length, number of views, poster identity and other relevant information were compiled. Video understandability and actionability were assessed by physician-reviewers (PR) with the Patient Education Materials Assessment Tool for audiovisual materials (PEMAT A/V), while the DISCERN tool appraised quality. Sponsorship presence, patient vs health care professional narratives, and intended audience were documented. Thematic analysis of most discussed topics was performed. Additionally, cluster analysis was employed to categorize the videos based on their quality. Results: Of 109 videos (mean length: 7 mins.), 67% had sponsorship (of which 45% corporate); 92% were information-based (vs experience-based); 82% targeted general population over BC patients; 93.6% were in AL, and 5.5% had translation. Mean PEMAT scores were 61.3% (understandability) and 20% (actionability). Mean DISCERN score was 2.6/5. Only 21% of videos featured women. Predominant themes were awareness (82.6%), appearance, and body image (68.8%). Less prevalent: sexuality and fertility (4.6%). The likelihood that the PR would recommend the video to a patient was low at 43.1%. Cluster analysis showed that high-quality videos had a higher understandability (74%), actionability (40.5%) and greater likelihood of being recommended by a PR (90.5%). Conclusions: YT content on PMR for ASW is easily understandable but lacks actionability and has moderate overall quality. Videos are highly sponsored and questionably representative of patients’ and women’s perspective. Therefore, Improving YT content, especially in AL, is crucial for supporting BC patients exploring PMR. The identified themes and insights into gender representation provide valuable guidance for content creators aiming to improve digital resources for this digitally connected demographic.

Post mastectomy reconstruction choice: Do race and ethnicity play a role?

1586 Background: The choice regarding reconstruction after mastectomy is based on multiple factors. We hypothesized that race and ethnicity are associated with decision making regarding reconstruction and choice for bilateral mastectomy among a diverse patient population with equal access to reconstructive options. Methods: A retrospective cohort study was performed of patients who underwent mastectomy with or without reconstruction for cancer or prophylaxis from 1/1/2019-12/31/2020 within a single health care system. Clinical and demographicfeatures were recorded. Study endpoints included reconstruction and contralateral prophylactic mastectomy (CPM) choice. Chi square and logistic regression analyses were performed with hypotheses tested at 5% significance level. Results: A total of 663 patients underwent mastectomy for cancer or prevention. Mean age was 54 (range: 24-93) and median BMI 25 (15-58). The majority of women included identified as Non-Hispanic White (NHW) (52%), with other women identifying as Hispanic, Asian, Non-Hispanic Black (NHB), or Other (Table). Of the total cohort, 647 (98%) patients had surgery for cancer, while 16 (2%) had surgery for prophylaxis. Among those with unilateral cancer (N=602, 91%), NHW women were more likely to get CPM (OR 2.12, p<.001), while NHB (OR 0.58, p=.02) and Asian women (OR 0.47, p=.01) were less likely to choose CPM. Asian women were less likely to undergo reconstruction compared to non-Asian women (OR=0.42, p=.01), while Hispanic women were almost twice as likely to undergo reconstruction compared to non-Hispanic women (OR 1.93, p=.016). Hispanic women were more likely to undergo a DIEP flap (OR 2.77, p <.001), while NHW women were more likely to choose implant reconstruction (OR 2.35, p<.001). Conclusions: In our hospital system, choice for reconstruction or CPM was found to differ based on race and ethnicity. NHW women were more likely to choose CPM and undergo implant-based reconstruction, Asian women were more likely to forgo reconstruction, and Hispanics were more likely to undergo DIEP flaps. Future analysis in this cohort will include other factors such as BMI, insurance status, religion, marital status, and employment status.[Table: see text]

Physical well-being recovery trajectories by reconstruction modality in women undergoing mastectomy and breast reconstruction: Significant predictors and health-related quality of life outcomes.

We sought to identify trajectories of patient-reported outcomes, specifically physical well-being of the chest (PWBC), in patients who underwent postmastectomy breast reconstruction, and further assessed its significant predictors, and its relationship with health-related quality of life (HRQOL). We used data collected as part of the Mastectomy Reconstruction Outcomes Consortium study within a 2-year follow-up in 2012-2017, with 1422, 1218,1199, and 1417 repeated measures at assessment timepoints of 0,3,12, and 24 months, respectively. We performed latent class growth analysis (LCGA) in the implant group (IMPG) and autologous group (AUTOG) to identify longitudinal change trajectories, and then assessed its significant predictors, and its relationship with HRQOL by conducting multinomial logistic regression. Of the included 1424 patients, 843 were in IMPG, and 581 were in AUTOG. Both groups experienced reduced PWBC at follow-up. LCGA identified four distinct PWBC trajectories (χ2 = 1019.91, p<0.001): low vs medium high vs medium low vs high baseline PWBC that was restored vs. not-restored after 2 years. In 76.63%(n = 646) of patients in IMPG and 62.99% (n = 366) in AUTOG, PWBC was restored after two years. Patients in IMPG exhibited worse PWBC at 3 months post-surgery than that in AUTOG. Patients with low baseline PWBC that did not improve at 2-year follow up (n = 28, 4.82% for AUTOG) were characterized by radiation following reconstruction and non-white ethnicity. In IMPG, patients with medium low-restored trajectory were more likely to experience improved breast satisfaction, while patients developing high-restored trajectories were less likely to have worsened psychosocial well-being. Although more women in IMPG experienced restored PWBC after 2 years, those in AUTOG exhibited a more favorable postoperative trajectory of change in PWBC. This finding can inform clinical treatment decisions, help manage patient expectations for recovery, and develop rehabilitation interventions contributing to enhancing the postoperative quality of life for breast cancer patients.

Factors Affecting the Outcome of Breast Reconstruction Surgery in Modified Radical Mastectomy Procedure

Background: Breast cancer is the leading cause of death in women caused by cancer. The primary treatment for breast cancer is surgery, where several recommended surgical methods are breast-conserving surgery or mastectomy. Postoperative mastectomy reconstruction has provided an opportunity to overcome the emotional and aesthetic burden of malignancy.&#x0D; Methods: This research is a descriptive observational study with a retrospective approach. The sample was 45 breast cancer patients who had undergone a modified radical mastectomy operation at Dr. Kariadi General Hospital for January 2019 - April 2023. The data were processed using SPSS for Windows software, and a descriptive analysis was carried out.&#x0D; Results: Most of the patients who underwent post-MRM breast reconstruction were in the age group &gt;40 years (71.1%), had stage 2 mammary carcinoma (44.4%) and stage 3 (40%), featured invasive ductal carcinoma (84 .4%), breast on the right side (64.4%). Some suffer from hypertension (13.3%) or diabetes mellitus (22.2%). The most used type of reconstruction was STSG (82.2%). A small proportion of patients experienced dehiscence (17.8%). In the Karnofsky score assessment, the highest score was 70 (64.4%), followed by 60 (17.8%), 80 (11.1%), 50 (4.4%), and 40 (2.2%).&#x0D; Conclusion: The patients undergoing MRM are dominated by the age group &gt; 40 years, not suffering from hypertension or diabetes mellitus, stage 2, histopathology of invasive ductal carcinoma, right-sided breast. STSG dominates the choice of reconstruction with postoperative complications in the form of dehiscence in a small proportion of patients. The Karnofsky score is dominated by a score of 70.

Outcomes of breast reconstruction in patients with stage IV breast cancer

Patients with Stage IV breast cancer are living longer but breast reconstruction in this setting remains controversial. There is limited research evaluating the benefits of breast reconstruction in this patient cohort. Drawing from the Mastectomy Reconstruction Outcomes Consortium (MROC) dataset, a prospective cohort study that involved 11 leading medical centers in the US and Canada, we compared patient-reported outcomes (PROs) assessed utilizing the BREAST-Q, a condition-specific, validated patient-reported outcome measure (PROM) for mastectomy reconstruction, as well as complications between a cohort of patients with Stage IV disease undergoing reconstruction and a control group of women with Stage I-III disease also receiving reconstruction. Among the MROC population, 26 patients with Stage IV and 2613 women with Stage I-III breast cancer underwent breast reconstruction. Preoperatively, the Stage IV cohort reported significantly lower baseline scores for satisfaction with breast (p=0.004), psychosocial well-being (p=0.043) and sexual well-being (p=0.001), compared with Stage I-III women. Following breast reconstruction, Stage IV patients' mean PRO scores improved over baseline and were not significantly different from those of Stage I-III reconstruction patients. There were also no significant differences in overall/any (p=0.782), major (p=0.751) or minor complication (p=0.787) rates between the two groups at two years following reconstruction. The findings in this study suggest that breast reconstruction offers significant quality-of-life benefits for women with advanced breast cancer with no increase in postoperative complications and thus may be a reasonable option in this clinical setting.

Virtual Reality and Augmented Reality in Plastic and Craniomaxillofacial Surgery: A Scoping Review.

Virtual reality (VR) and augmented reality (AR) have evolved since their introduction to medicine in the 1990s. More powerful software, the miniaturization of hardware, and greater accessibility and affordability enabled novel applications of such virtual tools in surgical practice. This scoping review aims to conduct a comprehensive analysis of the literature by including all articles between 2018 and 2021 pertaining to VR and AR and their use by plastic and craniofacial surgeons in a clinician-as-user, patient-specific manner. From the initial 1637 articles, 10 were eligible for final review. These discussed a variety of clinical applications: perforator flaps reconstruction, mastectomy reconstruction, lymphovenous anastomosis, metopic craniosynostosis, dermal filler injection, auricular reconstruction, facial vascularized composite allotransplantation, and facial artery mapping. More than half (60%) involved VR/AR use intraoperatively with the remainder (40%) examining preoperative use. The hardware used predominantly comprised HoloLens (40%) and smartphones (40%). In total, 9/10 Studies utilized an AR platform. This review found consensus that VR/AR in plastic and craniomaxillofacial surgery has been used to enhance surgeons' knowledge of patient-specific anatomy and potentially facilitated decreased intraoperative time via preoperative planning. However, further outcome-focused research is required to better establish the usability of this technology in everyday practice.

The Intercostal Artery Perforator Flap: Expanding Breast-Conserving Therapy With a Modified Oncoplastic Approach.

Historically, breast-conserving surgery may not be pursued when the oncologic deformity is too significant and/or not tolerant of radiotherapy. Reconstruction using recruitment of upper abdominal wall tissue based on the intercostal artery perforating vessels can expand breast conservation therapy indications for cases that would otherwise require mastectomy. This report aims to describe the expanded use of the intercostal artery perforator (ICAP) as well as detail its ease of adoption. All patients who underwent ICAP flaps for reconstruction of partial mastectomy defects at a single institution were included. Demographic data, intraoperative data, and postoperative outcomes were recorded. Intercostal artery perforator flap outcomes are compared with standard alloplastic reconstruction after mastectomy. Twenty-seven patients received ICAP flaps compared with 27 unilateral tissue expanders (TE). Six cases included nipple-areolar reconstruction, and 6 included skin resurfacing. The average defect size was 217.7 (30.3-557.9) cm 3 . Plastic-specific operative time was significantly longer in the ICAP cohort ( P < 0.01) with no difference in total operative time ( P > 0.05). Length of stay was significantly longer, and major postoperative complications were significantly more common in TE patients ( P < 0.01, P > 0.05). Seven TE patients required outpatient opiate refills (26%) versus 1 ICAP patient (4%) ( P = 0.02). One ICAP patient required additional surgery. Patients reported satisfaction with aesthetic outcomes. Average follow-up in the ICAP cohort was 7 months. Lumpectomy reconstruction using ICAP flaps can effectively expand breast conservation therapy indications in resection of breast skin, nipple-areola, or large volume defects. This technique is adoptable and of limited complexity. Enhancing breast-conserving surgery may improve outcomes compared with mastectomy reconstruction. Intercostal artery perforator patients may require fewer opioids, shorter hospital stays, and lower operative burden.

Postmastectomy breast reconstruction for women with hereditary gastric and breast cancer syndrome.

Post mastectomy reconstruction is nowadays an integral part of breast cancer treatment, usually performed in the immediate setting. Among women with hereditary gastric and breast cancer syndromes, three different scenarios can be identified. First, healthy women seeking for prophylactic mastectomies. Second, cancer patients requiring mastectomy at the tumor site and simultaneous risk reducing mastectomy of the healthy breast. Third, cancer patients who have been treated for primary cancer requiring risk reducing mastectomies in a further stage. In this paper, we present a schematic guide for reconstruction for each subpopulation of subjects and their peculiarities.

Immediate reconstruction of the breast with implants and prolene mesh for early breast cancer

Abstract Introduction: Several techniques are available today for immediate breast reconstruction after mastectomy for breast cancer in early stage and the choice depends on patient condition, experience and surgeon skills. It is possible to use a definitive implant or a muscle flap to reconstruct breast, this procedure was performed under general anesthesia and immediately following a total mastectomy. While using a tissue expander requires two surgical procedures. Patients and methods: We study a series of patients with early breast cancer who underwent total mastectomy and immediate breast reconstruction with implants in a submuscular pocket created beneath the pectoralis major muscle and prolene mesh. The study has conducted at the Breast Department – Oncology Center of Cho Ray Hospital from 04/2020 to 04/2021. Results: There were 25 patients with early breast cancer (Stage 0: 6 cases, Stage IA: 2 cases, Stage IIA: 17 cases), in which, two cases had neoadjuvant therapy. A total of 17 nipple-sparing mastectomy reconstructions and 8 skin-sparing mastectomy reconstructions were performed during the study period. Mean age were 45,4 ± 9,2 years old (from 30 to 63). Mean operation time were 239 ± 26,4 minutes. No major complications were recorded. There is one case with skin redness and one case with partial nipple ischemia, these cases were stable when discharging from the hospital. In cosmetic aspect, results were excellent achieved 20% and good 80% respectivelly. The patients had been follow-up and treated with multi disciplinary specialty consultant after surgery, no case needs adjuvant radiotherapy. No recurrence or distal metastasis was recorded. Conclusion: Mastectomy and immediate breast reconstruction with implant in early breast cancer is feasible with strict condition. However, further studies with a larger sampling size and a follow-up are necessary to draw more validated conclusions. Keywords: breast cancer, immediate breast reconstruction.

Patterns of ischaemia and reperfusion in nipple-sparing mastectomy reconstruction with indocyanine green angiography

Intraoperative assessment of mastectomy flaps and nipple-areola complex (NAC) with indocyanine green angiography (ICGA) for decision-making in delayed breast reconstruction after nipple-sparing mastectomy (NSM) remains to be fully elucidated. We evaluated patterns of ischaemia and reperfusion in NSM with delayed breast reconstruction and their outcomes. Single-institution retrospective study of delayed implant-based breast reconstructions following NSM due to poor perfusion analysis on ICGA. Intraoperative ICGA perfusion values and fluorescence patterns during the delayed and subsequent reconstruction operations were analysed. Fifty-six (45 patients) delayed breast reconstructions following NSM were performed. The median time to reconstruction was seven days (range, 4-21 days). A total of 112 fluorescence images were reviewed. Four patterns of ischaemia were identified during initial mastectomy (Type I, diffuse ischaemia; Type II, geographic ischaemia; Type III, incisional ischaemia; Type IV, NAC only ischaemia). All, but 1 breast, had adequate reperfusion during delayed reconstruction. Obesity (BMI ≥ 30) was associated with Type I ischaemia (p<0.001). Mean ICGA absolute and relative perfusion values during initial mastectomy were significantly lower than the perfusion values during delayed reconstruction (absolute value 6.7 versus 40.2 units, p<0.001; relative value 10% versus 44%, p<0.001, respectively). There were no cases of partial-thickness or full-thickness necrosis. Delaying breast reconstruction for NSM with ischaemia predicted by ICGA may allow blood supply to the flap and NAC to improve, reducing the risk for necrosis. Distinct patterns of ischaemia and low perfusion values with ICGA may be used in the decision to delay reconstruction.

Follow up Case on Breast Reconstruction with ADM

Breast cancer is the most common type of cancer found in women after skin cancer. It is also the second cause of cancer death in women after lung cancer. The incidence of breast cancer has decreased in the last decade due to the discontinuation of hormone replacement therapy in postmenopausal women The majority of women with breast cancer are in an early stage at the moment of detection and are eligible for breast conservation therapy and receive some form of systemic or local adjuvant therapy like chemotherapy or radiotherapy depending on the histological type of the tumor. Acellular dermal matrices or ADM for short are processed dermis that can be used as an adjuvant to local flap reconstruction or as the primary material for reconstruction of the nipple. In this article we discuss the case of a 42 year old woman with breast carcinoma who underwent mastectomy and breast reconstruction with silicone gel implant and ADM and answered a set of questions created to optimize the patient journey from diagnosis to reconstruction and follow-up.

QS31. Patient-reported Outcomes as a Clinical Vital Sign: BREAST-Q Implementation Lessons and Clinical Reference Values

Background: The BREAST-Q is the gold standard patient-reported outcome measure (PROM) of health-related quality of life and patient satisfaction following breast reconstruction. However, the routine, longitudinal implementation of the BREAST-Q has been challenging, so the BREAST-Q remain underutilized in patient care. We describe our institution’s improvements to BREAST-Q clinical implementation through increasing patient engagement and creating reference values. Methods: We reviewed BREAST-Qs completed by postmastectomy breast reconstruction patients at Memorial Sloan Kettering Cancer Center (MSK) in 2011-2019. In 2018, we began implementing BREAST-Q as a vital sign; BREAST-Qs were automatically administered before every encounter through an online patient portal. Clinics had a “BREAST-Q Champion” to troubleshoot implementation issues, assisted by a digital dashboard that tracked response rates. We examined annual BREAST-Q completion rates for 2011-2019. Annual completion rates prior to quality-improvement intervention were compared to those after intervention. Based on 2011-2017 scores, descriptive statistics were used to create reference values for BREAST-Q satisfaction subscales at preoperative and 6 months, 1 year, and 2 years after surgery and for BREAST-Q quality-of-life subscales at preoperative and 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years after surgery. Separate reference values were generated for implant and autologous patients. Reference values were externally validated by comparing patient characteristics and BREAST-Q scores between the MSK and the Mastectomy Reconstruction Outcomes Consortium (MROC) study cohorts. Results: Out of 109,435 requested BREAST-Qs, 41,981 BREAST-Qs were completed. Of BREAST-Qs requested within 2-years of surgery, the average annual BREAST-Q completion rate increased from 42.8% in 2011-2017 to 87.6% in 2019, the last full year of our study period. High completion rates were maintained January-July 2020; however, a significantly larger proportion of BREAST-Qs were completed at home in 2020 versus the same period in 2019 (49.7% vs. 38.8%, p<0.001), potentially due to the COVID-19 pandemic. Reference values were based on 3268 MSK patients (2932 implant, 336 autologous) and validated with 2814 MROC patients (1958 implant, 856 autologous). Overall, few timepoint comparisons between the datasets reached clinically meaningful and statistical difference. Clinically important differences between MSK and MROC cohorts were most prevalent at 3 months after surgery, with MSK cohort patients having higher Psychosocial Wellbeing (Implants: +9.4 points, p<0.001; Autologous: +4.7 points, p=0.019) and Sexual Wellbeing (Implants: +6.1 points, p<0.001). By 1 year after surgery, differences between MSK and MROC cohorts diminished. Reference values were used to create the BREAST-Q Reconstruction Engagement and Communication Tool (REACT) for implant and autologous patients. Conclusion: Sustained, routine implementation of BREAST-Q is possible, and REACT adds to the clinical applicability of BREAST-Q by providing context to a numerical score.

Outcomes after skin-reducing mastectomy and immediate hybrid breast reconstruction using combination of acellular dermal matrix and de-epithelialized dermal flap in large and/or ptotic breasts

Outcomes after skin-reducing mastectomy and immediate hybrid breast reconstruction using combination of acellular dermal matrix and de-epithelialized dermal flap in large and/or ptotic breasts

BREAST-Q REACT: Clinical Reference Values for the BREAST-Q in Post-mastectomy Breast Reconstruction Patients.

The BREAST-Q is the most commonly used patient-reported outcome measure (PROM) for breast reconstruction research. However, clinical implementation of this PROM has been impeded by a lack of context for score interpretation. The aim of this study was to define reference values for the BREAST-Q at discrete timepoints following surgery, generating a tool for real-time score interpretation. BREAST-Q scores were prospectively obtained in women who underwent implant or autologous post-mastectomy breast reconstruction preoperatively and for 2 years following surgery at Memorial Sloan Kettering Cancer Center (MSK). Descriptive statistics were used to create reference values for BREAST-Q satisfaction and quality-of-life subscales. Reference values were externally validated by comparing patient characteristics and BREAST-Q scores between the MSK and the Mastectomy Reconstruction Outcomes Consortium (MROC) study cohorts. Overall, 3268 MSK patients and 2814 MROC patients were included for analysis. When MSK and MROC cohorts were compared for validation, there were some statistical differences in BREAST-Q scores; however, most of these differences did not meet the minimal clinically important difference of 4 points. Reference values were used to create the BREAST-Q Real-time Engagement and Communication Tool (REACT). Using a large cohort of patients, we have defined BREAST-Q reference values for post-mastectomy breast reconstruction patients for use in clinical practice. The BREAST-Q REACT will help breast reconstruction providers gauge patient wellbeing and satisfaction relative to the "average" breast reconstruction patient and determine which patients may benefit from additional intervention.

A Comparison of Complications in Therapeutic versus Contralateral Prophylactic Mastectomy Reconstruction: A Paired Analysis.

Although breast reconstruction after bilateral mastectomies including a contralateral prophylactic mastectomy is known to have a higher overall complication profile, whether reconstructive complication rates differ between the therapeutic mastectomy and contralateral prophylactic mastectomy sides remains unclear. Women undergoing bilateral mastectomies with autologous or implant-based breast reconstruction for a unilateral breast cancer at a single institution were identified (2009 to 2019). Postoperative complications were stratified by laterality (therapeutic mastectomy versus contralateral prophylactic mastectomy). Paired data were analyzed to compare the risks of complications between prophylactic and therapeutic reconstruction sides in the same patient. A total of 130 patients (260 reconstructions) underwent bilateral autologous or implant-based reconstruction. Although most women underwent a simple mastectomy, a higher proportion of therapeutic mastectomies were modified radical mastectomies including axillary lymph node dissections compared to contralateral prophylactic mastectomies (15.4 percent versus 0 percent). Forty-four percent of women completed postmastectomy radiation therapy of the therapeutic side before definitive reconstruction. Overall, both therapeutic and prophylactic reconstructions had a similar incidence of reconstructive failure (p = 0.57), return to the operating room (p = 0.44), mastectomy skin flap necrosis (p = 0.32), seroma (p = 0.82), fat necrosis (p = 0.16), wound infection (p = 0.56), and cellulitis (p = 0.56). Nearly one-fifth of patients experienced complications limited to the prophylactic side [contralateral prophylactic mastectomy reconstruction complications, n = 26 (20.0 percent); therapeutic mastectomy reconstruction complications, n = 15 (11.5 percent)]. Despite a history of local radiation therapy and more extensive oncologic surgery on the therapeutic side, there are no significant differences in the incidence of postsurgical complications on the therapeutic mastectomy and contralateral prophylactic mastectomy sides after bilateral reconstruction. Risk, II.

Abstract P3-21-03: Timing of post-mastectomy radiation therapy and autologous reconstruction outcomes: A retrospective review

Abstract Introduction: Post-mastectomy radiation therapy (PMRT) is an important adjuvant treatment in patients with locally advanced breast cancer, shown to decrease the rate of locoregional recurrence and improve overall survival. Autologous breast reconstruction is the standard-of-care in patients who require PMRT. However, there is no clear superior approach regarding the optimal timing of reconstruction in these patients. Our goal was to compare outcomes between patients who underwent autologous reconstruction either before or after undergoing PMRT. Methods: We performed a retrospective chart review of patients who underwent all stages of mastectomy, autologous reconstruction, and PMRT at UCSF between 2015 and 2021. Clinical and surgical characteristics and complications were collected and assessed. We then matched these patients by age, BMI and autologous reconstruction type to a cohort of patients who underwent both mastectomy and autologous reconstruction at UCSF who did not require PMRT. Groups were compared by both timing of and receipt of radiation. Results: Nineteen patients underwent mastectomy, autologous reconstruction, and PMRT at UCSF between 2015 and 2021. Thirteen of these patients underwent reconstruction after receiving PMRT, while six of these patients underwent reconstruction followed by PMRT. These nineteen patients were matched by age, BMI and flap type to a cohort of 19 patients who underwent mastectomy and autologous reconstruction at UCSF. The cumulative early complication rate was 16% in the radiated group and 21% in the non-radiated group. This included infection requiring IV antibiotics, hematoma, wound breakdown, mastectomy flap necrosis, and arterial or venous thrombosis [see Table 1 for breakdown by group]. No flap loss occurred in any group. Fat necrosis was observed in 16% of radiated patients and 11% of non-radiated patients. Revision rates were equal between the radiated and non-radiated groups at 58% (including currently planned revisions). There was no strong correlation between complication rate and either total radiation dose or time between radiation and reconstruction (r=-0.5 and r=-0.1). Discussion: Complication rates between all groups were similar. Notably, the only observed infections, both requiring admission and IV antibiotics, occurred in the pre-reconstruction PMRT group. Given the potential for tissue expander infection and increased number of outpatient visits, further investigation is warranted in immediate autologous reconstruction in those patients who require PMRT, not only to decrease the hospital and patient burden, but to improve patient satisfaction. Larger cohort studies are required to draw further conclusions on the effect of PMRT and timing of autologous reconstruction, and to investigate patient-reported outcomes. Table 1.Complication rate by groupComplicationRadiated. Pre-recon PMRT. Post-recon PMRTNon-radiatedCumulative early complications16%. 15%. 17%21%Infection11%. 16%. 0%0%Hematoma0%. 0%. 0%5%Wound breakdown11%. 8%. 17%5%Mastectomy flap necrosis5%. 0%. 17%11%Arterial or venous thrombosis0%. 0%. 0%5%Fat necrosis16%. 15%. 17%11%Revision58%. 62%. 50%58% Citation Format: Laura Barnes, Deborah Martins, Merisa Piper. Timing of post-mastectomy radiation therapy and autologous reconstruction outcomes: A retrospective review [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-21-03.

Current trends in breast reconstruction.

Breast reconstruction is nowadays a component of surgical treatment of breast cancer; therefore plastic surgeons are widely involved in breast reconstruction procedures either after mastectomy or after wide quadrantectomy. The aim is to reduce the distortion of breast shape and to improve the aesthetic outcome of the oncological procedure taking in account the symmetric appearance of the breasts. In post quadrantectomy reconstruction, breast reshaping with mammoplasty pattern could be applied in large and ptotic breast; otherwise flaps from lateral thoracic area could be used as well in post mastectomy reconstruction. In the case of mastectomy, the mastectomy procedure itself has become increasingly conservative, thus allowing an improvement in the aesthetic results of the reconstruction, especially if an implant is used. If adequate thickness of the mastectomy flap is preserved, the prosthesis can be placed in front of the muscle (prepectoral reconstruction), rather than behind the muscle (submuscular reconstruction). In prepectoral reconstruction the postoperative recovery is easier and less distressing for the patient and the postoperative appearance is more natural then in submuscular reconstruction. Autologous breast reconstruction implies the use of flaps (tissue taken from donor areas and used to reconstruct the breast area after appropriate molding), this technique allows to obtain a natural appearance of the breast with similar characteristics to the original one, and can be used in the radiated field. Different options of flaps include flaps from back area (local flaps) and flaps from distant areas (free flaps), basically from abdomen and inner tight.

166 An audit of Patient Satisfaction after Breast Reconstruction and Presentation of a Novel Decision-Making Aid for Oncological Breast Surgery Patients

Abstract Background Breast reconstruction presents women with life-changing decisions at a time of immense pressure due to a concurrent cancer diagnosis. Objectives To assess whether patient satisfaction with breast care teams, patient autonomy in pre-operative consultation and information provision at Ysbyty Glan Clwyd (YGC) met the standards published in the National Mastectomy and Breast Reconstruction Audit (NMBRA), 2011. To use data collected to generate a novel decision-making aid. Method A patient satisfaction questionnaire, ‘Betsi-Q’, was created and sent to 100 mastectomy patients from YGC. Statistical significance was tested using Chi-squared test, T-test (Yates correction) and Z- score. Results Completed questionnaires were returned by 44 respondents (44%). Although shy of the 90% NMBRA recommendation, patient satisfaction with the team was reported high in 35/41 respondents (85%). The audit identified 36 respondents (86%) felt they made an informed decision regarding breast reconstruction, exceeding the 80% NMBRA recommendation. Information regarding the emotional and sexual benefits of breast reconstruction over mastectomy alone, were discussed with 10 respondents (26%), despite recommendations to discuss with all patients. Exploration of more than one option for breast reconstruction was only reported in 29/42 respondents (70%), below the 90% NMBRA recommendation. Conclusions Patient satisfaction with the team at YGC is high but efforts to ensure all patients are making an informed decision should be made. The decision-making tool designed alongside this audit aims to address these recommendations. Early identification and correction of misinformation, along increasing the variety of resources for patient education will be beneficial to manage expectations and enhance patient experience.

Routine Postoperative Antibiotics After Tissue Expander Placement Postmastectomy Does Not Improve Outcome.

In an attempt to reduce the incidence of infectious complications after tissue expander-based breast reconstruction, the routine administration of postoperative antibiotics regimen is common in many practices. In recent years, there has been a plethora of reports scrutinizing the prophylactic use of postoperative antibiotics in this setting. The aim of this study was to determine the efficacy of prolonged administration of postoperative antibiotics compared with perioperative-only antibiotic administration for prophylaxis after tissue expander placement for immediate mastectomy reconstruction. A retrospective chart review of all patients who underwent immediate tissue expander placement after mastectomy at our institution from June 2005 to September 2018 was performed. All patients in the study received perioperative intravenous antibiotics 30 to 60 min preoperatively and for 24 hours postoperatively. Patients were divided into 2 groups. Patients in group A did not receive antibiotics beyond the perioperative period. Patients in group B received oral antibiotics for at least 7 days postoperatively in addition to the perioperative intravenous antibiotics. The 2 groups were compared for demographics and prevalence of risk factors such as radiation, chemotherapy, smoking, and diabetes. The incidence of complications such as infection, wound complications, hematoma, seroma, capsular contracture, loss of tissue expander, and reoperations was assessed. A total of 529 patients were included in the study, of which 241 were in group A and 288 were in group B. The total number of breasts reconstructed in group A was 398, whereas in group B, it was 466 breasts. Patients were followed up to 5 months postoperatively in each group. There were no statistically significant differences in the demographic and patient characteristics among the 2 groups. The incidence of infection in group A was 23.24% and in group B was 21.53% (P = 0.412). The incidence of other complications follows the same trend when comparing group A versus B. This retrospective study shows that the routine use of postoperative antibiotics after tissue expander placement for immediate mastectomy reconstruction does not result in reduction in the incidence of common complications or improvement of clinical outcomes.