World Journal of Surgery

, Volume 34, Issue 12, pp 3029–3035 | Cite as

Surgical Decision-making in Immediate Breast Reconstruction

  • Kylie J. Musgrave
  • Melissa Bochner
  • James Kollias
Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

References

  1. 1.
    The NHS Information Centre (2008) First annual report of the national mastectomy and breast reconstruction audit 2008. The NHS Information Centre, London, UKGoogle Scholar
  2. 2.
    National Breast and Ovarian Cancer Centre (2009) National Breast and Ovarian Cancer Centre and Royal Australasian College of Surgeons, National Breast Cancer Audit, Public Health Monitoring Series 2007 Data. National Breast and Ovarian Cancer Centre, Sydney, AustraliaGoogle Scholar
  3. 3.
    Newman LA, Kuerer HM, Hunt KK et al (1999) Feasibility of immediate breast reconstruction for locally advanced breast cancer. Ann Surg Oncol 6:671–675CrossRefPubMedGoogle Scholar
  4. 4.
    Trinconi AF, Pinotti JA, Fonseca AM (2007) Oncologic progression of patients with advanced breast carcinoma undergoing immediate breast reconstruction. Int J Gynaecol Obstet 97:50–51CrossRefPubMedGoogle Scholar
  5. 5.
    Whitfield GA, Horan G, Irwin MS et al (2009) Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractions. Radiother Oncol 90(1):141–147CrossRefPubMedGoogle Scholar
  6. 6.
    Behranwala KA, Dua RS, Ross GM et al (2006) The influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants. J Plast Reconstr Aesthet Surg 59:1043–1051CrossRefPubMedGoogle Scholar
  7. 7.
    Tran NV, Chang DW, Gupta A et al (2001) Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 108:78–82CrossRefPubMedGoogle Scholar
  8. 8.
    Tran NV, Evans GR, Kroll SS et al (2000) Postoperative adjuvant irradiation: effects on transverse rectus abdominis muscle flap breast reconstruction [see comment]. Plast Reconstr Surg 106:313–317; discussion 318-320CrossRefPubMedGoogle Scholar
  9. 9.
    Rogers NE, Allen RJ (2002) Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap. Plast Reconstr Surg 109:1919–1924; discussion 1925-1916CrossRefPubMedGoogle Scholar
  10. 10.
    Mortenson MM, Schneider PD, Khatri VP et al (2004) Immediate breast reconstruction after mastectomy increases wound complications: however, initiation of adjuvant chemotherapy is not delayed. Arch Surg 139:988–991CrossRefPubMedGoogle Scholar
  11. 11.
    Alderman AK, Wilkins EG, Kim HM et al (2002) Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 109:2265–2274CrossRefPubMedGoogle Scholar
  12. 12.
    Pinsolle V, Grinfeder C, Mathoulin-Pelissier S et al (2006) Complications analysis of 266 immediate breast reconstructions. J Plast Reconstr Aesthet Surg 59:1017–1024CrossRefPubMedGoogle Scholar
  13. 13.
    Woerdeman LA, Hage JJ, Hofland MM et al (2007) A prospective assessment of surgical risk factors in 400 cases of skin-sparing mastectomy and immediate breast reconstruction with implants to establish selection criteria. Plast Reconstr Surg 119:455–463CrossRefPubMedGoogle Scholar
  14. 14.
    Spear SL, Onyewu C (2000) Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg 105:930–942CrossRefPubMedGoogle Scholar
  15. 15.
    Thomson HJ, Potter S, Greenwood RJ et al (2008) A prospective longitudinal study of cosmetic outcome in immediate latissimus dorsi breast reconstruction and the influence of radiotherapy. Ann Surg Oncol 15:1081–1091CrossRefPubMedGoogle Scholar
  16. 16.
    Contant CM, van Geel AN, van der Holt B et al (2000) Morbidity of immediate breast reconstruction (IBR) after mastectomy by a subpectorally placed silicone prosthesis: the adverse effect of radiotherapy. Eur J Surg Oncol 26:344–350CrossRefPubMedGoogle Scholar
  17. 17.
    McKeown DJ, Hogg FJ, Brown IM et al (2009) The timing of autologous latissimus dorsi breast reconstruction and effect of radiotherapy on outcome. J Plast Reconstr Aesthet Surg 62:488–493CrossRefPubMedGoogle Scholar
  18. 18.
    Schechter NR, Strom EA, Perkins GH et al (2005) Immediate breast reconstruction can impact postmastectomy irradiation. Am J Clin Oncol 28:485–494CrossRefPubMedGoogle Scholar
  19. 19.
    Motwani SB, Strom EA, Schechter NR et al (2006) The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys 66:76–82CrossRefPubMedGoogle Scholar
  20. 20.
    McGuire K, Rosenberg AL, Showalter S et al (2007) Timing of sentinel lymph node biopsy and reconstruction for patients undergoing mastectomy. Ann Plast Surg 59:359–363CrossRefPubMedGoogle Scholar
  21. 21.
    Woerdeman LA, Hage JJ, Smeulders MJ et al (2006) Skin-sparing mastectomy and immediate breast reconstruction by use of implants: an assessment of risk factors for complications and cancer control in 120 patients. Plast Reconstr Surg 118:321–330; discussion 331-322CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Kylie J. Musgrave
    • 1
    • 2
  • Melissa Bochner
    • 1
    • 2
  • James Kollias
    • 1
    • 2
  1. 1.Department of SurgeryThe University of AdelaideAdelaideAustralia
  2. 2.Department of Breast, Endocrine and Surgical OncologyRoyal Adelaide HospitalAdelaideAustralia

Personalised recommendations