Rates Of Immediate Reconstruction Research Articles

Primary Reconstruction of Mandibular Defects after Resection of Aggressive Pediatric Mandibular Tumors by Split Rib Bundle Bone Graft. A Retrospective Study

Background: A retrospective study was done to evaluate the success rate of immediate reconstruction by split rib bundle bone grafting after segmental resection of Aggressive Pediatric mandibular tumors. Materials and Patients: The present study enrolled sixty-one pediatric patients with aggressive mandibular tumors that had been treated during the period from January 2008 to December 2018. All patients were examined clinically and radiographically by Orthopantomograms, CTs and CBCTs. Radical segmental resection with resultant mandibular continuity defects were thus created followed by immediate reconstruction with non-vascularized Split Rib Bundle Bone Graft (SRBBG). Patients were then rehabilitated by osseointegrated implants with fixed or removable partial dentures. Success of reconstruction was assessed by the percentage of complications, interincisal opening and patient satisfaction. Assessment was performed at 1,3,6 and 12 months postoperatively. All patients were followed up for 4-7 years. Results: Successful reconstruction was accomplished in 55 patients (90.16 %). Successful dental rehabilitation was accomplished in 49 patients (89%). Three patients had complete failure due to severe postoperative infection. Another three cases had partial resorption of the graft due to moderate infection to whom re-augmentation by another rib graft had been performed. Conclusion: Pediatric aggressive mandibular tumors should be treated in an aggressive manner relative to its biologic behavior and immediate reconstruction is advocated. The Split Rib Bundle Bone Graft is an adequate alternative for mandibular reconstruction in the absence of microvascular surgery as it shows early revascularization thus permitting rehabilitation with successfully osseointegrated dental implants.

Immediate Reconstruction Swing Room Scheduling Reduces Wait Times to Surgery and Increases Breast Reconstruction Rates

Despite benefits in quality of life, patient satisfaction, overall healthcare costs, and number of surgeries, historically fewer than 30% of patients undergo immediate breast reconstruction following mastectomy for breast cancer. A paucity of qualified oncologic and plastic surgeons coupled with inefficient use of operating room (OR) resources presents challenges in offering immediate breast reconstruction in a timely manner. To address these challenges, an immediate reconstruction swing room (IRSW) program was developed. IRSW scheduling leverages two concurrently running ORs, with the surgical oncologist and plastic surgeon moving between rooms to complete 2-4 combined mastectomy cases with immediate reconstruction, in addition to 1-2 independent cases, each operative day. The final year of traditional booking was compared with IRSW scheduling to assess wait times and reconstruction rates. Comparing the 2years, fewer surgical breast cases were performed with IRSW scheduling (1250 vs. 1178), however the overall number of oncology cases increased from 735 (59%) to 857 (73%). The number of immediate reconstructions performed increased from 75 to 139 (p < 0.0001), which reflects a mean of 1.2 IR cases versus 2.9 combined cases in IRSW. Overall, this facilitated an increase in the rate of immediate reconstruction following therapeutic mastectomy from 35 to 49% (p = 0.0004) and decreased wait times from core biopsy to surgery from 70 to 52days (p < 0.0001). A multidisciplinary model with optimized scheduling has the potential to improve resource utilization and access to breast cancer care.

Mastectomy patterns, but not rates, are changing in the treatment of early breast cancer. Experience of a single European institution on 2315 consecutive patients

BackgroundRecent literature reports that rates of mastectomy are increasing in early breast cancer. However, data from European institutions are limited and revealed conflicting results. We report on 15-year trends of mastectomy, mastectomy plus immediate reconstruction and contralateral prophylactic mastectomy (CPM) at an academic institution. MethodsWe identified women diagnosed with unilateral early breast cancer at stage 0-IIa, with tumour size ≤ 4 cm, between 2002 and 2016. Trends were assessed using the Cochrane–Armitage test. Multivariable logistic regression was used to identify factors associated with receipt of mastectomy plus immediate reconstruction. ResultsA total of 2315 patients were identified. Of them, 65.7% underwent breast conserving surgery (BCS), while 34.3% underwent mastectomy as upfront surgery. Two point four per cent also received CPM. Immediate reconstruction was performed in 36.0% of patients receiving mastectomy. There was no change in trends of mastectomy over the 15 years studied (p = 0.69), as well as in trends of patients undergoing CPM (p = 0.44). In contrast, rates of immediate reconstruction rose significantly over the study period (from 12.2% in 2002 to 62.7% in 2016, p < 0.0001). Women were more likely to receive mastectomy plus immediate reconstruction if they were aged 50 years or younger, or had tumours larger than 2 cm, or had non-invasive carcinoma. ConclusionsOur study suggests that rates of both mastectomy and CPM in early breast cancer are not increasing, while use of immediate reconstruction is on the rise.

Factors Influencing the Rate of Post-Mastectomy Breast Reconstruction in a Canadian Teaching Hospital.

Post-mastectomy breast reconstruction (PMBR) improves psychosocial well-being, quality of life, and body image. Reconstruction rates vary widely (up to 42% in the United States), but the few Canadian studies available report rates of 3.8% to 7.9%. We sought to evaluate the current state of breast reconstruction in 1 Canadian teaching hospital and factors determining patients' access to reconstruction. We performed a retrospective chart review of all patients with breast cancer undergoing mastectomy alone or mastectomy and reconstruction at a Canadian hospital between 2010 and 2013. We calculated rates of breast reconstruction and compared patient characteristics between the 2 groups, and then performed a multiple logistic regression to determine factors increasing the odds of receiving breast reconstruction. A total of 152 patients underwent 154 total or modified radical mastectomies. We obtained a rate of PMBR of 21%, 14% immediate reconstruction, and 8% delayed. Statistical analysis showed that compared to patients with mastectomy alone, patients who received PMBR were significantly younger, with a larger percentage having bilateral mastectomies, non-invasive breast cancer, and residing further from the hospital. Patients less than 50 years old and those with bilateral mastectomies had significantly greater odds of having a reconstruction. Our Canadian tertiary care institution has a high volume of breast surgery and an active breast reconstruction team. However, the rate of immediate reconstruction remains low compared to similar centers in the United States. We recommend a united effort to increase awareness regarding PMBR and address common misconceptions hindering patients' access to breast reconstruction. Epidemiologic study, Level III.

Abstract P3-14-13: Total mastectomy and immediate breast reconstruction for breast cancer: A ten-year Canadian single institution experience

Abstract Fear of high local recurrence rate associated with immediate breast reconstruction (IBR) following total mastectomy for breast cancer might be a contributing factor to the low rate of immediate reconstruction performed in Quebec. The aim of this study was to demonstrate the oncological safety of total mastectomy with immediate breast reconstruction. A retrospective chart review of all patients who underwent total mastectomy with immediate breast reconstruction at the University of Montreal Hospital Center between 2006 and 2015 was performed. 375 patients (420 cases) met the inclusion criteria. The mean age was 51.5 years (25-77). The median follow-up was 45.6 months (0.4-115.2). Clinical cancer staging was done according to the American Joint Committee on Cancer (AJCC) criteria. 349 cases (83.1%) were classified as Stage &amp;lt; cIIb and 71 cases (16.9%) as ≥ cIIb. 73 patients (19.5%) received neoadjuvant chemotherapy, 113 (30.1%) received adjuvant chemotherapy and 91 (21.7%) received postoperative radiotherapy. Only 4 patients (3.5%) had a significant delay in receiving adjuvant chemotherapy and 4 patients (4.4%) had a delay in initiation of radiotherapy. In total, there were 12 (2.6%) local recurrences and 29 (7.7%) distant recurrences. The results of this study demonstrate a low rate of local recurrence that is comparable to the current litterature. Total mastectomy in association with immediate breast reconstruction is therefore an oncologically safe approach for the treatment of breast cancer and should be more widely adopted by medical centers throughout Quebec. Citation Format: Younan RJ, Al Khaldi M, Maalouf C, Guez M, Boulva K, robidoux A, Nassif E, Poljicak M, BouMerhi J, Bernier C, Patocskai E. Total mastectomy and immediate breast reconstruction for breast cancer: A ten-year Canadian single institution experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-13.

Does Immediate Tissue Expander Placement Increase Immediate Postoperative Complications in Patients with Breast Cancer?

The objectives of this study were to evaluate 1) the rate of immediate breast reconstruction; 2) the frequency of immediate tissue expander placement; and 3) to compare perioperative outcomes in patients who underwent breast reconstruction after mastectomy for breast cancer with immediate tissue expander placement (TE) with those with no reconstruction (NR). Using the Nationwide Inpatient Sample database, we examined the clinical data of patients with breast cancer who underwent mastectomy with or without immediate TE from 2006 to 2010 in the United States. A total of 344,253 patients with breast cancer underwent mastectomy in this period in the United States. Of these patients, 31 per cent had immediate breast reconstruction. We only included patients with mastectomy and no reconstruction (NR: 237,825 patients) and patients who underwent only TE placement with no other reconstruction combination (TE: 61,178 patients) to this study. Patients in the TE group had a lower overall postoperative complication rate (2.6 vs 5.5%; P < 0.01) and lower in-hospital mortality rate (0.01 vs 0.09%; P < 0.01) compared with the NR group. Fifty-three per cent of patients in the NR group were discharged the day of surgery compared with 36 per cent of patients in the TE group. Using multivariate regression analyses and adjusting patient characteristics and comorbidities, patients in the TE group had a significantly lower overall complication rate (adjusted odds ratio [AOR], 0.6) and lower in-hospital mortality (AOR, 0.2) compared with the NR group. The rate of immediate reconstruction is 31 per cent. TE alone is the most common type of immediate reconstruction (57%). There is a lower complication rate for the patients who underwent immediate TE versus the no-reconstruction cohort.

Shared decision-making: applying a person-centered approach to tailored breast reconstruction information provides high satisfaction across a variety of breast reconstruction options.

A person-centered approach to co-decision-making using tailored information respects each woman's preferences and may heighten breast reconstruction satisfaction. Women seeking breast reconstruction underwent initial and follow-up consultations wherein suitable options were discussed, and take-away material, balanced website links, and access to a nurse specialist and peer volunteers was provided. After reconstruction, the BRECON-31(©) was administered and analyzed in three groups: autologous, alloplastic, and latissimus dorsi (LD)/implant. BRECON-31(©) subscale scores were compared between the groups, and multiple regression used to determine if the type of reconstruction independently predicted satisfaction. One hundred twenty three of 176 (70%) women completed the questionnaire (43% autologous, 47% alloplastic, and 10% LD/implant reconstructions). The LD/implant group had a low rate of immediate reconstruction (8.3%, P = 0.04), and the highest rate of chemotherapy (91.7%, P = 0.002) and radiation (100%, P = 0.003). The alloplastic group had a high rate of bilateral reconstruction (86.8%, P = 0.01). All groups scored well on the self-image, arm concerns, intimacy, satisfaction, and expectations subscales. All groups scored moderately on the self-consciousness, appearance, and nipple subscales. The autologous group scored the lowest on recovery (51 vs. 68 and 65, P < 0.0001) and only moderately well on the abdomen subscale (67). Multiple regression analysis showed that satisfaction was not driven by type of reconstruction (P > 0.05). High satisfaction can be achieved using a person-centered approach by providing detailed information, appreciating each woman's unique features, and tailoring the reconstruction plan to the individual. Recovery remains a particular challenge, especially for women undergoing autologous reconstruction.

Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England

This paper summarises the findings of a national audit of mastectomy and breast reconstruction surgery carried out in England. It describes patterns of treatment, and the clinical and patient-reported quality of life outcomes associated with these types of procedure. Prospective cohort study. All 150 National Health Service hospital groups (NHS trusts) in England that provided mastectomy or breast reconstruction surgery, along with six NHS trusts in Wales and Scotland and 114 independent hospitals. Women aged 16 years and over undergoing mastectomy with or without immediate breast reconstruction, or primary delayed breast reconstruction, between 1st January 2008 and 31st March 2009. Reconstructive utilisation, post-operative complications and sequelae, and patient-reported satisfaction and quality of life. Overall, 21% of the 16,485 women who had mastectomy underwent immediate reconstruction. However, the proportion varied between regions from 9% to 43% (p<0.001). Levels of patient satisfaction with information, choice and the quality of care were high. The proportion of women who experienced local complications was 10.30% (95% CI 9.78-10.84) for mastectomy surgery, ranged from 11.02% (9.31-12.92) to 18.24% (14.80-22.10) for different immediate reconstructive procedures, and from 5.00% (2.76-8.25) to 19.86% (16.21-23.94) for types of delayed reconstruction. Breast appearance and overall well-being scores reported 18 months after surgery were higher among women having immediate breast reconstruction compared to mastectomy only. Postoperative outcomes were similar across providers.. The Audit found women were highly satisfied with their peri-operative care, with hospital providers achieving similar outcomes. English providers should examine how to reduce the variation in rates of immediate reconstruction.

Nationwide Trends in Hospital Charges and Length of Stay for Immediate Breast Reconstruction

INTRODUCTION: We sought to analyze the trends in total hospital charges and length of stay among patients undergoing immediate breast reconstruction – both implant based and autologous. METHODS: Nationwide Inpatient Sample was queried from 2000 to 2009 using ICD-9 codes to identify patients undergoing mastectomy and immediate reconstruction.1 This data was analyzed to follow the rates of implant based and autologous immediate reconstruction, total hospital charges and length of stay over this time frame. Statistical significance was assessed using linear regression and ANOVA using SPSS. RESULTS: After applying discharge weights, a total of 782418 patients underwent mastectomy during the study period, out of which 253238 underwent immediate reconstruction. Rate of immediate reconstruction increased from 26.3% in 2000 to 43.9% in 2009 (p<0.001). Rate of implant based reconstruction increased from 50.6% of total reconstructions to 74.9% of reconstructions in 2009. The median total charges(in dollars) for unilateral mastectomy without reconstruction increased from 7780 in 2000 to 17873 in 2009 (229.7%), whereas for bilateral mastectomy without reconstruction, the charges increased from 9867 in 2000 to 23958 in 2009 (242.8%). Median total charges for unilateral autologous reconstruction increased from 17356 in 2000 to 42140 in 2009 (242.8%), and for bilateral autologous reconstruction, they increased from 18275 in 2000 to 53015 in 2009 (290.1%). For implant-based reconstruction, total charges for unilateral procedures increased by 279.8% from 12981 in 2000 to 36320 in 2009, where as total charges for bilateral procedures increased from 16284 in 2000 to 46737 in 2009 (287%). This is significantly higher than the 3.5% per year rise in Medicare spending from 1992 to 2006.2 Adjusting for inflation using the PHCE Price Index from the CMS office of actuary allows for healthcare expenditure rise of 141% in this study period.3 The graphs show a comparison between expected and actual increase in total charges for these procedures accounting for inflation. The mean length of stay for patients undergoing implant-based reconstruction changed from 2.2 to 2.04 days. Mean length of stay for patients undergoing autologous reconstruction changed from 3.86 to 3.06 days. CONCLUSION: The mean total charges in all immediate reconstruction cases have shown a significant increase over the past decade, although the length of stay has decreased (Figures 1 and 2).Figure 1: Trends in total charges for autologous reconstruction (unilateral and bilateral).Figure 2: Trends in total charges for implant based reconstruction (unilateral and bilateral).

Surgical Decision‐making in Immediate Breast Reconstruction

Immediate breast reconstruction has been accepted as safe and practical after mastectomy for breast cancer; factors limiting its use are patient comorbidities and potential complications caused by adjuvant therapies (particularly radiotherapy). The aim of this study was to identify factors considered by surgeons when deciding whether to offer immediate breast reconstruction, to determine the surgeon's accuracy when predicting postmastectomy radiotherapy, and to assess the impact of premastectomy investigations on decision-making. Four oncoplastic breast surgeons completed a survey for every mastectomy performed over an 11-month period. On the survey form they indicated reason for mastectomy, investigations available premastectomy, if they offered immediate reconstruction, and if not offered, why they did not offer it. Data on adjuvant therapies employed was also collected. A total of 157 women underwent mastectomy during the study period. Seventy-six (48.4%) were offered immediate reconstruction and 36 (22.9%) accepted. The most common reason for not offering immediate reconstruction was the predicted need for postmastectomy radiotherapy (56.8%). Of the 76 patients offered immediate reconstruction, 9 went onto be offered postmastectomy radiotherapy (11.8%). Decision-making was no more accurate in those women who had MRI, axillary staging, or excisional pathology available premastectomy. The most common reason for not offering immediate breast reconstruction is the need for postmastectomy radiotherapy and surgeons are able to predict this accurately. The addition of invasive and expensive staging investigations premastectomy does not appear to assist this decision-making process. Despite careful patient selection, a high rate of immediate reconstruction may be maintained.

The rate of immediate reconstruction following mastectomy for breast cancer varies by patient race

The rate of immediate reconstruction following mastectomy for breast cancer varies by patient race