Effect of health care disparities on procedure selection of autologous breast reconstruction in Florida

2021 ◽  
pp. 1-6
Author(s):  
Maria T. Huayllani ◽  
Ricardo A. Torres-Guzman ◽  
Francisco R. Avila ◽  
Pooja P. Advani ◽  
Aaron C. Spaulding ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Health Care Disparities ◽  
Statistical Significance ◽  
Private Insurance ◽  
Pedicled Flap ◽  
South Florida ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction

INTRODUCTION: Disparities in access to reconstructive surgery after breast cancer have been reported. We aim to evaluate demographic and socioeconomic factors influencing type of autologous breast reconstruction in Florida. METHODS: We queried the Florida Inpatient Discharge Dataset to evaluate disparities in type of autologous breast reconstructive surgery between January 1, 2013, and September 30, 2017. Patients 18 years of age or older were included. Women younger than 65 years old on Medicare were excluded. Patients were categorized into three groups according to type of autologous reconstruction: latissimus dorsi pedicled flap (pedicled flap), free flap, or pedicled flap with implant (combined flap). Demographic and socioeconomic variables were evaluated. 𝜒2 and Mann–Whitney tests were used to estimate statistical significance. A multivariate logistic regression was performed to find independent associations. RESULTS: Our results showed higher odds of reconstruction with free flap in Hispanic patients (odds ratio (OR), 1.66; 95% CI, 1.32–2.09; P < 0.0001) and patients with comorbidities (OR, 1.45; 95% CI, 1.23–1.71; P < 0.0001). However, patients treated in Central and South Florida were less likely to undergo free flap than combined and pedicled flap reconstructions compared with those treated in North Florida (P < 0.05). Patients insured by Medicaid and Medicare were less likely to undergo free flap than combined or pedicled flap reconstruction compared to patients with private insurance (P < 0.05). CONCLUSIONS: Our study identified that race, region, insurance, and comorbidity are factors associated with type of autologous breast reconstruction in Florida.

scholarly journals Use of Closed Incision Negative Pressure Therapy (ciNPT) in Breast Reconstruction Abdominal Free Flap Donor Sites

2021 ◽  
Vol 10 (21) ◽  
pp. 5176
Author(s):  
Jennifer Wang ◽  
Zyg Chapman ◽  
Emma Cole ◽  
Satomi Koide ◽  
Eldon Mah ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Negative Pressure ◽  
Statistical Significance ◽  
Future Research ◽  
Wound Complications ◽  
Negative Pressure Therapy ◽  
Royal Melbourne Hospital ◽  
Pressure Therapy ◽  
The Impact

Background: Closed incision negative pressure therapy (ciNPT) may reduce the rate of wound complications and promote healing of the incisional site. We report our experience with this dressing in breast reconstruction patients with abdominal free flap donor sites. Methods: A retrospective cohort study was conducted of all patients who underwent breast reconstruction using abdominal free flaps (DIEP, MS-TRAM) at a single institution (Royal Melbourne Hospital, Victoria) between 2016 and 2021. Results: 126 female patients (mean age: 50 ± 10 years) were analysed, with 41 and 85 patients in the ciNPT (Prevena) and non-ciNPT (Comfeel) groups, respectively. There were reduced wound complications in almost all outcomes measured in the ciNPT group compared with the non-ciNPT group; however, none reached statistical significance. The ciNPT group demonstrated a lower prevalence of surgical site infections (9.8% vs. 11.8%), wound dehiscence (4.9% vs. 12.9%), wound necrosis (0% vs. 2.4%), and major complication requiring readmission (2.4% vs. 7.1%). Conclusion: The use of ciNPT for abdominal donor sites in breast reconstruction patients with risk factors for poor wound healing may reduce wound complications compared with standard adhesive dressings; however, large scale, randomised controlled trials are needed to confirm these observations. Investigation of the impact of ciNPT patients in comparison with conventional dressings, in cohorts with equivocal risk profiles, remains a focus for future research.

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.

The laparoscopically harvested omentum as a free flap for autologous breast reconstruction

Microsurgery ◽  
2016 ◽  
Vol 37 (6) ◽  
pp. 539-545 ◽  
Author(s):  
Tert C. van Alphen ◽  
Maarten R. Fechner ◽  
Jeroen M. Smit ◽  
Gerrit D. Slooter ◽  
Coralien L. Broekhuysen
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Autologous Breast Reconstruction

Evolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy

2018 ◽  
Vol 141 (5) ◽  
pp. 1086-1093 ◽  
Author(s):  
Jordan D. Frey ◽  
John T. Stranix ◽  
Michael V. Chiodo ◽  
Michael Alperovich ◽  
Christina Y. Ahn ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Autologous Breast Reconstruction ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Patient-Reported Satisfaction and Quality of Life in Postmastectomy Radiated Patients: A Comparison between Delayed and Delayed Immediate Autologous Breast Reconstruction in a Predominantly Minority Patient Population

2019 ◽  
Vol 35 (06) ◽  
pp. 445-451 ◽  
Author(s):  
George N. Kamel ◽  
David Nash ◽  
Joshua Jacobson ◽  
Robin Berk ◽  
Karan Mehta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Breast Reconstruction ◽  
Medical Center ◽  
Tissue Expander ◽  
Well Being ◽  
Minority Population ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Patient Reported

Background Delayed immediate (DI) autologous breast reconstruction consists of immediate postmastectomy tissue expander placement, radiation therapy, and subsequent autologous reconstruction. The decision between timing of reconstructive methods is challenging and remains to be elucidated. We aim to compare patient reported outcomes and quality of life between delayed and DI reconstruction. Methods A retrospective review of all patients, who underwent autologous breast reconstruction at Montefiore Medical Center from January 2009 to December 2016, was conducted. Patients who underwent postmastectomy radiotherapy were divided into two cohorts: delayed and DI autologous breast reconstruction. Patients were mailed a BREAST-Q survey and their responses, demographic information, complications, and need for revisionary procedures were analyzed. Results A total of 79 patients met inclusion criteria: 34.2% (n = 27) in the delayed and 65.8% (n = 52) in the DI group. 77.2% (n = 61) of patients were a minority population. Patients in each cohort had similar baseline characteristics; however, the DI cohort was more likely to have bilateral reconstruction (46.2% [n = 24] vs. 7.4% [n = 2]; p = 0.0005) and to have major mastectomy flap necrosis (22.4% [n = 17] vs. 0.0% [n = 0]; p = 0.002). Premature tissue expander removal occurred in 17.3% (n = 9) of patients in the DI group. BREAST-Q response rates were 44.4% (n = 12) in the delayed group and 57.7% (n = 30) in the DI group. Responses showed similar satisfaction with their breasts, well-being, and overall outcome. Conclusion Delayed and DI autologous breast reconstruction yield similar patient-reported satisfaction; however, patients undergoing DI reconstruction have higher rates of major mastectomy necrosis. Furthermore, patients in the DI group risk premature tissue expander removal.

scholarly journals Patterns of Post-Mastectomy Radiotherapy in Immediate Breast Reconstruction – Results from the iBRA-2 Cohort Study

2021 ◽  
Author(s):  
Tim Rattay ◽  
Adam Trickey ◽  
Rachel L O'Connell ◽  
Rajiv V Dave ◽  
Joanna Skillman ◽  
...  
Keyword(s):  
Cohort Study ◽  
Breast Reconstruction ◽  
Free Flap ◽  
Immediate Breast Reconstruction ◽  
Pedicled Flap ◽  
Reconstruction Technique ◽  
Breast Cancer Patients ◽  
The North ◽  
Lower Stage ◽  
The Uk

Abstract PurposeLong-term data indicates that post-mastectomy radiotherapy (PMRT) is associated with improved overall survival in all node-positive breast cancer patients. Immediate breast reconstruction (IBR) remains controversial in the context of planned PMRT, but rates of IBR are increasing. The aim of this study was to examine current practice of PMRT in patients undergoing mastectomy +/- IBR.MethodsData were collected from 2,526 patients enrolled in the iBRA-2 prospective cohort study undergoing mastectomy +/- IBR between 1st July and 31st December 2016, recruited consecutively at 71 centres across the United Kingdom, Ireland, and five international centres.ResultsOf a total of 2,590 breast procedures included in the analysis, 696 were implant-based, 105 pedicled flap and 230 free-flap reconstruction. 31.4% of implant-based, 34.3% of pedicled, and 32.5% of free-flap reconstructions were recommended for PMRT. PMRT recommendation by cancer stage was 21% for T1-2 N0, 65% for T1-2 N1, and 89% for Tany N2 and T3 Nany disease. On multivariate analysis, patients undergoing IBR were no less likely to be recommended for PMRT than patients having mastectomy only. However, patients in Northern Ireland/Ireland, the North of England, and Scotland were less likely to be recommended for PMRT.ConclusionAlthough IBR was more likely to be performed for lower stage cancers and younger patients with fewer co-morbidities, patients undergoing IBR were no less likely to be recommended for PMRT, irrespective of reconstruction technique. This study also highlighted regional variation in PMRT practice within the UK which merits further investigation.

scholarly journals The Retrograde Limb of the Internal Mammary Artery: An Alternative Inflow Option for Free Flap Breast Reconstruction

2020 ◽  
Vol 25 (4) ◽  
pp. 326-330
Author(s):  
Hyung Min Hahn ◽  
Bohwan Cha ◽  
Il Jae Lee
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Internal Mammary Artery ◽  
Ductal Carcinoma ◽  
Perforator Flap ◽  
Autologous Breast Reconstruction ◽  
Epigastric Artery ◽  
Internal Mammary ◽  
Deep Inferior Epigastric Artery ◽  
Arterial Insufficiency

Autologous breast reconstruction using a free flap is a popular option for breast reconstruction after mastectomy. The internal mammary system is the recipient of choice in autologous breast reconstruction. We present our experience utilizing the caudal limb of the internal mammary artery as the recipient artery. A 44-year-old female patient with invasive ductal carcinoma in her right breast received total mastectomy and reconstruction with the deep inferior epigastric artery perforator flap was planned. During the operation, arterial insufficiency occurred three times; therefore, we decided to change the plan and to perform anastomosis to the caudal limb of the internal mammary artery. Retrograde blood flow of the internal mammary artery was successfully achieved. Immediate postoperative and long-term outcomes of the flap were satisfactory. This inflow option may be useful in cases with arterial insufficiency on conventional anastomosis or in cases with bipedicled or stacked flaps for unilateral breast reconstruction.

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