Treatment Options for Bilateral Autologous Breast Reconstruction in Patients with Inadequate Donor-Site Volume

2017 ◽  
Vol 33 (05) ◽  
pp. 305-311 ◽  
Author(s):  
Michael Chu ◽  
Fares Samra ◽  
Suhail Kanchwala ◽  
Arash Momeni
Keyword(s):  
Breast Reconstruction ◽  
Lower Cost ◽  
Treatment Options ◽  
Donor Site ◽  
The United States ◽  
Immediate Breast Reconstruction ◽  
Autologous Reconstruction ◽  
Microsurgical Reconstruction ◽  
Tissue Reconstruction

AbstractMore than 250,000 women will be diagnosed with invasive breast cancer in the United States in 2017 alone. A large number of these patients will undergo mastectomy and will be candidates for immediate breast reconstruction. The most common reconstructive options are either implant-based or autologous tissue reconstruction, with the latter having been reported to have higher rates of long-term patient satisfaction, lower cost, and less postoperative pain. A subset of patients, however, may not be ideal candidates for autologous microsurgical reconstruction, for example, due to inadequate abdominal tissues, yet they may desire this reconstructive modality. This is particularly challenging in patients requiring bilateral reconstructions. In this article, the authors discuss the various reconstructive modalities that can be considered in patients who desire bilateral breast reconstruction, are not ideal candidates for autologous reconstruction, yet do not wish to rely solely on implant-based modalities.

scholarly journals Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study

2017 ◽  
Vol 35 (22) ◽  
pp. 2499-2506 ◽  
Author(s):  
Andrea L. Pusic ◽  
Evan Matros ◽  
Neil Fine ◽  
Edward Buchel ◽  
Gayle M. Gordillo ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Patient Reported Outcomes ◽  
Well Being ◽  
Immediate Breast Reconstruction ◽  
Measurement Information ◽  
Autologous Reconstruction ◽  
Patient Reported ◽  
Tissue Reconstruction ◽  
Immediate Implant ◽  
Implant Reconstruction

Purpose The goals of immediate postmastectomy breast reconstruction are to minimize deformity and optimize quality of life as perceived by patients. We prospectively evaluated patient-reported outcomes (PROs) in women undergoing immediate implant-based or autologous reconstruction. Methods Women undergoing immediate postmastectomy reconstruction for invasive cancer and/or carcinoma in situ were enrolled at 11 sites. Women underwent implant-based or autologous tissue reconstruction. Patients completed the BREAST-Q, a condition-specific PRO measure for breast surgery patients, and Patient-Reported Outcomes Measurement Information System–29, a generic PRO measure, before and 1 year after surgery. Mean changes in PRO scores were summarized. Mixed-effects regression models were used to compare PRO scores across procedure types. Results In total, 1,632 patients (n = 1,139 implant, n = 493 autologous) were included; 1,183 (72.5%) responded to 1-year questionnaires. After analysis was controlled for baseline values, patients who underwent autologous reconstruction had greater satisfaction with their breasts than those who underwent implant-based reconstruction (difference, 6.3; P < .001), greater sexual well-being (difference, 4.5; P = .003), and greater psychosocial well-being (difference, 3.7; P = .02) at 1 year. Patients in the autologous reconstruction group had improved satisfaction with breasts (difference, 8.0; P = .002) and psychosocial well-being (difference, 4.6; P = .047) compared with preoperative baseline. Physical well-being of the chest was not fully restored in either the implant group (difference, −3.8; P = .001) or autologous group (−2.2; P = .04), nor was physical well-being of the abdomen in patients who underwent autologous reconstruction (−13.4; P < .001). Anxiety and depression were mitigated at 1 year in both groups. Compared with their baseline reports, patients who underwent implant reconstruction had decreased fatigue (difference, −1.4; P = .035), whereas patients who underwent autologous reconstruction had increased pain interference (difference, 2.0; P = .006). Conclusion At 1 year after mastectomy, patients who underwent autologous reconstruction were more satisfied with their breasts and had greater psychosocial and sexual well-being than those who underwent implant reconstruction. Although satisfaction with breasts was equal to or greater than baseline levels, physical well-being was not fully restored. This information can help patients better understand expected outcomes and may guide innovations to improve outcomes.

scholarly journals A Qualitative Assessment of the Journey to Delayed Breast Reconstruction

2017 ◽  
Vol 25 (3) ◽  
pp. 157-162 ◽  
Author(s):  
Ho Man Cheng ◽  
Catherine McMillan ◽  
Joan E. Lipa ◽  
Laura Snell
Keyword(s):  
Breast Reconstruction ◽  
Plastic Surgery ◽  
Cancer Diagnosis ◽  
Breast Cancer Survivors ◽  
Tertiary Care ◽  
The United States ◽  
Immediate Breast Reconstruction ◽  
Qualitative Assessment ◽  
Tertiary Care Centre ◽  
Delayed Breast Reconstruction

Background: Canada has low immediate breast reconstruction (IBR) rates compared to the United States and Europe. Breast cancer survivors live with mastectomy defects sometimes for years, and this represents an area for improvement in cancer care. Purpose: This study qualitatively assessed (1) information provided about breast reconstruction at the time of cancer diagnosis among women seeking delayed breast reconstruction (DBR) and (2) referral practices for plastic surgery consultation for DBR. Methods: Fifty-two consecutive patients seen in consultation for DBR at a single Canadian tertiary care centre completed questionnaires regarding their experience in seeking breast reconstruction. Seven semi-structured interviews were conducted to further explore themes identified through questionnaires. Questionnaire responses and interview transcripts were analyzed for recurring themes using standard qualitative techniques. Results: A significant portion of women (43%) was interested in reconstruction prior to mastectomy, yet IBR was infrequently discussed (14%) or discouraged by their oncologic surgeons (33%). Common patient reasons for not pursuing IBR were referring physician objection and not having adequate knowledge. Women expressed wanting to discuss reconstruction at the time of cancer diagnosis. Half of the patients had attended another consultation, but the initial plastic surgeon either did not offer procedures for which these women were candidates or had prohibitively long surgical wait times. Conclusion: Lack of information about reconstructive options at the time of cancer diagnosis and perceived access barriers to plastic surgeons may contribute to underutilization of IBR in Canada. Access to breast reconstruction can be improved by reducing inefficiencies in plastic surgery referrals.

Immediate Breast Reconstruction in The Netherlands and the United States

2019 ◽  
Vol 144 (4) ◽  
pp. 565e-574e
Author(s):  
Parisa Kamali ◽  
Annelotte van Bommel ◽  
Babette Becherer ◽  
Rodney Cooter ◽  
Marc A. M. Mureau ◽  
...  
Keyword(s):  
United States ◽  
The Netherlands ◽  
Breast Reconstruction ◽  
The United States ◽  
Immediate Breast Reconstruction

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

2015 ◽  
Vol 81 (2) ◽  
pp. 143-149
Author(s):  
Hossein Masoomi ◽  
Keyianoosh Z. Paydar ◽  
Gregory R. D. Evans ◽  
Emily Tan ◽  
Karen T. Lane ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Hospital Mortality ◽  
Breast Reconstruction ◽  
Complication Rate ◽  
Tissue Expander ◽  
The United States ◽  
Immediate Breast Reconstruction ◽  
Perioperative Outcomes ◽  
Immediate Reconstruction

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.

How Does Autologous Breast Reconstruction Impact Downtime?

2018 ◽  
Vol 34 (07) ◽  
pp. 530-536 ◽  
Author(s):  
Daniel Rais ◽  
Jian Farhadi ◽  
Giovanni Zoccali
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Diep Flap ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Superior Gluteal Artery ◽  
Free Flap Surgery ◽  
Recovery Times ◽  
Time Required ◽  
The Impact

Background Although autologous breast reconstruction is technically quite demanding, it offers the best outcomes in terms of durable results, patient perceptions, and postoperative pain. Many studies have focused on clinical outcomes and technical aspects of such procedures, but few have addressed the impact of various flaps on patient recovery times. This particular investigation entailed an assessment of commonly used flaps, examining the periods of time required to resume daily activities. Methods Multiple choice questionnaires were administered to 121 patients after recovery from autologous reconstruction to determine the times required in returning to specific physical activities. To analyze results, the analysis of variance F-test was applied, and odds ratios (ORs) were determined. Results Among the activities surveyed, recovery time was not always a function of free-flap surgery. Additional treatments and psychological effects also contributed. Adjuvant chemotherapy increased average downtime by 2 weeks, and postoperative irradiation prolonged recovery as much as 4 weeks. Patient downtime was unrelated to flap type, ranging from 2.9 to 21.3 weeks for various activities in question. Deep inferior epigastric perforator (DIEP) flaps yielded the highest OR and transverse upper gracilis (TUG) flaps the lowest. Conclusion Compared with superior gluteal artery perforator and TUG flaps, the DIEP flap was confirmed as the gold standard in autologous breast reconstruction, conferring the shortest recovery times. All adjuvant therapies served to prolong patient recovery as well. Surgical issues, patient lifestyles, and donor-site availability are other important aspects of flap selection.

Effects of Sterilization Techniques and Culture Time on the Creep of Collagenous Ligament Analogues

2002 ◽  
Author(s):  
Darryl A. Dickerson ◽  
Kay C. Dee ◽  
Glen A. Livesay
Keyword(s):  
Cruciate Ligament ◽  
Donor Site ◽  
Critical Role ◽  
The United States ◽  
Donor Site Morbidity ◽  
Joint Stability ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Active Patients

Every year, approximately 200,000 anterior cruciate ligament (ACL) injuries occur in the United States; of these cases, 60,000–75,000 patients undergo ACL reconstruction [1]. The ACL plays a critical role in knee stability; however, it possesses little inherent capacity for healing. Although reconstruction is often used in active patients, issues such as donor site morbidity and long term joint stability have motivated interest in tissue-engineered ligament analogues.

Surgical Intervention for Refractory Donor-Site Seroma After Immediate Breast Reconstruction with Latissimus Dorsi Flap

2019 ◽  
Vol 43 (6) ◽  
pp. 1515-1522
Author(s):  
Joon Seok Lee ◽  
Hyun Ki Hong ◽  
Jong Seong Kim ◽  
Dong Hun Choi ◽  
Jeong Woo Lee ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Surgical Intervention ◽  
Donor Site ◽  
Immediate Breast Reconstruction ◽  
Latissimus Dorsi Flap
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