National trends and complication rates after bilateral mastectomy and immediate breast reconstruction from 2005 to 2012

2015 ◽  
Vol 210 (3) ◽  
pp. 512-516 ◽  
Author(s):  
Alvin C. Kwok ◽  
Isak A. Goodwin ◽  
Jian Ying ◽  
Jayant P. Agarwal
Keyword(s):  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
Bilateral Mastectomy ◽  
Complication Rates ◽  
National Trends

scholarly journals National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy

2017 ◽  
Vol 33 (05) ◽  
pp. 312-317 ◽  
Author(s):  
Shantanu Razdan ◽  
Peter Cordeiro ◽  
Claudia Albornoz ◽  
Joseph Disa ◽  
Hina Panchal ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
Complication Rates ◽  
Postmastectomy Radiotherapy ◽  
National Breast ◽  
Related Quality ◽  
Health Related ◽  
Rate Ratios ◽  
National Trends

Background Immediate breast reconstruction (IBR) is often deferred, when postmastectomy radiotherapy (PMRT) is anticipated, due to high complication rates. Nonetheless, because of robust data supporting improved health-related quality of life associated with reconstruction, physicians and patients may be more accepting of tradeoffs. The current study explores national trends of IBR utilization rates and methods in the setting of PMRT, using the National Cancer Database (NCDB). The study hypothesis is that prosthetic techniques have become the most common method of IBR in the setting of PMRT. Methods NCDB was queried from 2004 to 2013 for women, who underwent mastectomy with or without IBR. Patients were grouped according to PMRT status. Multivariate logistic regression was used to calculate odds of IBR in the setting of PMRT. Trend analyses were done for rates and methods of IBR using Poisson regression to determine incidence rate ratios (IRRs). Results In multivariate analysis, radiated patients were 30% less likely to receive IBR (p < 0.05). The rate increase in IBR was greater in radiated compared with nonradiated patients (IRR: 1.12 vs. 1.09). Rates of reconstruction increased more so in radiated compared with nonradiated patients for both implants (IRR 1.15 vs. 1.11) and autologous techniques (IRR 1.08 vs. 1.06). Autologous reconstructions were more common in those receiving PMRT until 2005 (p < 0.05), with no predominant technique thereafter. Conclusion Although IBR remains a relative contraindication, rates of IBR are increasing to a greater extent in patients receiving PMRT. Implants have surpassed autologous techniques as the most commonly used method of breast reconstruction in this setting.

Immediate Bilateral Breast Reconstruction Using Abdominally Based Flaps: An Analysis of the Nationwide Inpatient Sample Database

2019 ◽  
Vol 35 (08) ◽  
pp. 594-601 ◽  
Author(s):  
Kathleen A. Holoyda ◽  
Andrew M. Simpson ◽  
Xiangyang Ye ◽  
Jayant P. Agarwal ◽  
Alvin C. Kwok
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Nationwide Inpatient Sample ◽  
Free Flaps ◽  
Hospital Charges ◽  
Single Type ◽  
Bilateral Mastectomy ◽  
Complication Rates ◽  
Total Cost ◽  
Nationwide Inpatient Sample Database

Abstract Background Bilateral mastectomy rates are increasing in the United States. The abdomen is the most common harvest site for autologous reconstruction. Nationwide data were examined to determine differences in hospital charges, length of stay (LOS), and early postoperative complications following immediate bilateral pedicled transverse rectus abdominis myocutaneous (pTRAM), free TRAM (fTRAM), deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) perforator flaps and were compared with unilateral reconstruction. Methods Patients who underwent immediate bilateral breast reconstruction using a single method of abdominally based reconstruction were identified using the 2009 to 2014 Nationwide Inpatient Sample Database. Outcomes included total hospital charges, LOS, and immediate postoperative complications. Results We identified 13,348 cases of bilateral mastectomy with a single type of immediate bilateral autologous flap reconstruction. The majority were bilateral DIEP flaps. Mean total cost for bilateral pTRAM, fTRAM, DIEP, and SIEA flaps was US $21,886.80, US $28,839.40, US $30,051.30, and US $33,784.90, respectively (p < 0.0001). Mean LOS for bilateral pTRAM, fTRAM, DIEP, and SIEA was 4.3, 4.9, 4.5, and 5.4 days, respectively (p = 0.0002), and hematoma rates were 1.93, 2.61, 3.68, and 16.59%, respectively, (p = 0.0001), whereas return to the operating room for vascular anastomosis revision was 0, 1.63, 1.99, and 19.07%, respectively (p < 0.0001). Cost is less for unilateral pTRAM, fTRAM, and DIEP flaps (p < 0.0001). LOS is shorter for unilateral fTRAM versus bilateral (p < 0.0001). No differences were appreciated between unilateral and bilateral hematoma and reoperation rates for any reconstruction (p > 0.1). Conclusion Immediate complication rates were higher in bilateral free flaps compared with bilateral pedicled flaps. pTRAM and fTRAM flap reconstructions are still performed frequently with acceptable immediate results without considering long-term morbidity, aesthetics, and abdominal muscle function. Bilateral SIEA free flaps were associated with significantly higher total cost, LOS, and complication rates compared with other groups. Complications were similar between unilateral and bilateral reconstruction procedures. While cost is significantly greater for bilateral procedures compared with unilateral pTRAM, fTRAM, and DIEP flaps, it is not doubled.

National trends and predictors of mastectomy with immediate breast reconstruction

2021 ◽  
Author(s):  
Ava Mandelbaum ◽  
Morcos Nakhla ◽  
Young Ji Seo ◽  
Vishal Dobaria ◽  
Deanna J. Attai ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
National Trends

Underfinancing of 90.3% for Implant Costs of Prostheses and Expanders in DRG Revenues for Uni- and Bilateral Mastectomy with Immediate Breast Reconstruction

Onkologie ◽  
2010 ◽  
Vol 33 (11) ◽  
pp. 584-588 ◽  
Author(s):  
Volker R. Jacobs ◽  
Linda Rasche ◽  
Nadia Harbeck ◽  
Mathias Warm ◽  
Peter Mallmann
Keyword(s):  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
Bilateral Mastectomy

Allograft vs Xenograft Bioprosthetic Mesh in Tissue Expander Breast Reconstruction: A Blinded Prospective Randomized Controlled Trial

2021 ◽  
Author(s):  
Malke Asaad ◽  
Jesse C Selber ◽  
David M Adelman ◽  
Donald P Baumann ◽  
Victor J Hassid ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Breast Reconstruction ◽  
Controlled Trial ◽  
Tissue Expander ◽  
Final Analysis ◽  
Immediate Breast Reconstruction ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Dermal Matrix ◽  
Randomized Controlled

Abstract Background With the increased use of acellular dermal matrix (ADM) in breast reconstruction, the number of available materials has increased. There is a relative paucity of high-quality outcomes data for use of different ADMs. Objectives The goal of this study was to compare the outcomes between a human (HADM) and a bovine ADM (BADM) in implant-based breast reconstruction. Methods A prospective, single-blinded, randomized controlled trial was conducted to evaluate differences in outcomes between HADM and BADM for patients undergoing immediate tissue expander breast reconstruction. Patients with prior radiation to the index breast were excluded. Patient and surgical characteristics were collected and analyzed. Results From April 2011 to June 2016, a total of 90 patients were randomized to a mesh group, with 68 patients (HADM, 36 patients/55 breasts; BADM, 32 patients/48 breasts) included in the final analysis. Baseline characteristics were similar between the 2 groups. No significant differences in overall complication rates were identified between HADM (n = 14, 25%) and BADM (n = 13, 27%) (P = 0.85). Similar trends were identified for major complications and complications requiring reoperation. Tissue expander loss was identified in 7% of HADM patients (n = 4) and 17% of BADM patients (n = 8) (P = 0.14). Conclusions Similar complication and implant loss rates were found among patients undergoing immediate tissue expander breast reconstruction with HADM or BADM. Regardless of what material is used, careful patient selection and counseling, and cost consideration, help to improve outcomes and sustainability in immediate breast reconstruction. Level of Evidence: 2

Trends in immediate breast reconstruction and early complication rates among older women: A big data analysis

2017 ◽  
Vol 115 (7) ◽  
pp. 870-877 ◽  
Author(s):  
Parisa Kamali ◽  
Daniel Curiel ◽  
Charlotte L. van Veldhuisen ◽  
Alexandra E.M. Bucknor ◽  
Bernard T. Lee ◽  
...  
Keyword(s):  
Big Data ◽  
Data Analysis ◽  
Breast Reconstruction ◽  
Older Women ◽  
Big Data Analysis ◽  
Immediate Breast Reconstruction ◽  
Complication Rates ◽  
Early Complication

Postmastectomy Radiation of Latissimus Dorsi Myocutaneous Flap Reconstruction is Well Tolerated in Women with Breast Cancer

2012 ◽  
Vol 78 (10) ◽  
pp. 1122-1127 ◽  
Author(s):  
Brandice Durkan ◽  
Farin Amersi ◽  
Edward H. Phillips ◽  
Randy Sherman ◽  
Catherine M. Dang
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Chest Wall ◽  
Latissimus Dorsi ◽  
Myocutaneous Flap ◽  
Immediate Breast Reconstruction ◽  
Bilateral Mastectomy ◽  
Wound Complications ◽  
Postmastectomy Radiation ◽  
Latissimus Dorsi Myocutaneous Flap

Chest wall irradiation decreases locoregional recurrence and breast cancer-related mortality in women at high risk for recurrence after mastectomy. Many women undergoing mastectomy desire immediate breast reconstruction. Postmastectomy radiation therapy (PMRT), however, increases the risk of surgical complications and may adversely affect the reconstructed breast. We compared outcomes of immediate latissimus dorsi myocutaneous flap (Lat Flap) versus tissue expander/implant (EI) reconstruction after mastectomy followed by PMRT in 29 women with invasive breast cancer treated at a single institution between 2009 and 2011. Although patients undergoing EI reconstruction were slightly younger and more frequently underwent bilateral mastectomy, there were no major differences between the groups with respect to patient or tumor characteristics. With a median follow-up of 11 months (Lat Flap) and 13 months (EI) after completion of PMRT, there was a trend toward more wound complications requiring reoperation, including expander/implant loss (n = 3), in the EI group. Capsular contracture was the most common sequela of PMRT in the Lat Flap group (67%) but this was easily treated with capsulotomy at the time of nipple– areola reconstruction. Immediate breast reconstruction with a latissimus dorsi myocutaneous flap is a viable option for women undergoing mastectomy who are likely to require chest wall irradiation.

scholarly journals Trends in bilateral mastectomy for cases of unilateral breast cancer in a Brazilian institute over a 10-year period

Mastology ◽  
2021 ◽  
Vol 31 ◽  
Author(s):  
Francisco Pimentel Cavalcante ◽  
Paulo Goberlâneo de Barros Silva ◽  
Marcos Venicio Alves Lima
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
Bilateral Mastectomy ◽  
Contributing Factors ◽  
Unilateral Breast Cancer ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Unilateral Mastectomy ◽  
Type Of Surgery

Introduction: There has been a substantial increase worldwide in the number of women with unilateral breast cancer who undergo bilateral mastectomy. Possible contributing factors include the advent of nipple-sparing mastectomy (NSM) and an improvement in breast reconstruction techniques. This study evaluated the trend in bilateral mastectomy at the Ceará Cancer Institute in Brazil. Methods: Patients with unilateral breast cancer who underwent mastectomy and immediate breast reconstruction were evaluated retrospectively between 2009 and 2018. Clinical, pathological and surgical factors were analyzed to determine their possible effects on the type of surgery performed. Results: Of 121 patients, 77 (63.6%) were submitted to unilateral mastectomy, while 44 (36.4%) underwent bilateral mastectomy. Most were treated with NSM (n = 66; 54.5%), with this technique being significantly associated with bilateral mastectomy (p < 0.001). Bilateral mastectomy increased significantly over the period (p = 0.009; r2 = 0.592), but unilateral mastectomy did not (p = 0.417; r2 = 0.084). Age < 45 years (p = 0.007) and negative axilla (p = 0.003) were also associated with bilateral mastectomy, while axillary dissection was associated with unilateral mastectomy (p = 0.028). Multivariate analysis showed the 2016-2018 period to be an independent factor associated with bilateral mastectomy. Conclusions: These results corroborate the international literature. From 2010 onwards, there was a trend towards an increase in bilateral mastectomy with breast reconstruction. These data may contribute to multidisciplinary debates, facilitating the establishment of guidelines. Further studies are required to improve understanding of this phenomenon in Brazil.

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