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      Breast Reconstruction and Radiation Therapy : An Update

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          Abstract

          With the indications for radiation therapy in the treatment of breast cancer continuing to expand, many patients present for reconstruction having previously had radiation or having a high likelihood of requiring radiation following mastectomy. Both situations are challenging for the plastic surgeon, with different variables impacting the surgical outcome. To date, multiple studies have been performed examining prosthetic and autologous reconstruction in this setting. The purpose of this article was to provide a general platform for understanding the literature as it relates to reconstruction and radiation through an examination of recent systematic reviews and relevant recent publications. We examined this with a focus on the timing of the radiation, and within this context, examined the data from the traditional surgical outcomes standpoint as well as from a patient-reported outcomes perspective. The data provided within will aid in patient counseling and the informed consent process.

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          Most cited references52

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          Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer

          New England Journal of Medicine, 347(16), 1233-1241
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            A paradigm shift in U.S. Breast reconstruction: increasing implant rates.

            Despite its benefits in body image, self-esteem, sexuality, and quality of life, historically fewer than 25 percent of patients undergo immediate breast reconstruction. After passage of the Women Health and Cancer Rights Act, studies failed to demonstrate changes in reconstructive rates. A recent single-year report suggests significant shifts in U.S. breast reconstruction patterns. The authors' goal was to assess long-term trends in rates and types of immediate reconstruction. A serial cross-sectional study of immediate breast reconstruction trends was performed using the Nationwide Inpatient Sample database from 1998 to 2008. Data on mastectomies, reconstructive method (autologous/implant), and sociodemographic/hospital predictors were obtained. Immediate breast reconstruction rates increased on average 5 percent per year, from 20.8 percent to 37.8 percent (p < 0.01). Autologous reconstruction rates were unchanged. Implant use increased by an average of 11 percent per year (p < 0.01), surpassing autologous methods as the leading reconstructive modality after 2002. The strongest predictors of implant use were procedures performed after 2002, bilateral mastectomies, patients operated on in Midwest/West regions, and Medicare recipients. In contrast to bilateral mastectomies, which increased by 17 percent per year (p < 0.01), unilateral mastectomies decreased by 2 percent per year (p < 0.01). Bilateral mastectomy defects had significantly higher reconstruction rates than unilateral counterparts (p < 0.01). The significant rise in immediate reconstruction rates in the United States correlates closely to a 203 percent expansion in implant use. Although the reason for the increase in implant use is multifactorial, changes in mastectomy patterns, such as increased use of bilateral mastectomies, are one important contributor.
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              Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction.

              The aim of this study was to assess and compare the psychological outcome and satisfaction of patients whom underwent wide local excision, mastectomy alone and mastectomy with breast reconstruction. A total of 577 patients had different types of operations for primary breast cancer (254 (44%) had wide local excision, 202 (35%) had simple mastectomy and 121 (21%) had breast reconstruction). Psychosocial morbidity and satisfaction were studied retrospectively using self-evaluation questionnaires. The three different surgical groups were cross-matched into four different age group. Significant statistical differences existed between the three procedures regarding satisfaction and psychosocial morbidity (anxiety, depression, body image, sexuality and self-esteem) in favour of wide local excision followed by breast reconstruction. Greatest morbidity was seen in the mastectomy group. Patient satisfaction of cosmetic outcome and psychosocial aspects was greater with wide local excision than with breast reconstruction or mastectomy. However, since wide local excision is indicated in only a group of patients, breast reconstruction should be an option available to patients requiring mastectomy.
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                Author and article information

                Journal
                Plastic and Reconstructive Surgery
                Plastic and Reconstructive Surgery
                Ovid Technologies (Wolters Kluwer Health)
                0032-1052
                2017
                November 2017
                : 140
                : 60S-68S
                Article
                10.1097/PRS.0000000000003943
                29064923
                c03746e2-4c74-42dc-b92c-97fb93c213a3
                © 2017
                History

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