Radiotherapy Increases Major Complications and Complication-related Reconstruction Failures in Patients with Implant-based Breast Reconstruction

Purpose This study was designed to assess the impact of post-mastectomy radiation therapy (PMRT) on reconstruction complications and failures in patients undergoing mastectomy and different types of breast reconstruction.Methods We retrospectively identified 832 breast cancer patients who underwent mastectomy and breast reconstruction at Fudan University Shanghai Cancer Center between June 2001 and December 2015. Of these, 159 patients received PMRT, and 673 patients did not receive PMRT. The endpoints of the reconstruction outcomes included any complications, major complications, overall reconstruction failures and complication-related reconstruction failures. Multivariate analysis was applied to identify independent predictors of reconstruction outcomes in patients with different types of breast reconstruction. The nomogram model was built on the basis of the multivariate analysis to predict complication-related reconstruction failures.Results The median follow-up time was 58.5 months. Of all 832 patients, 394 patients received implant-based reconstruction, and 438 patients received autologous reconstruction. For patients with implant-based reconstruction, multivariate analysis showed that PMRT was associated with 3.16 times (95% CI 1.17-8.54, p=0.023) higher odds of major complications and 3.22 times (95% CI 1.01-10.20, p=0.047) higher odds of complication-related reconstruction failures but was not associated with any complications (OR 1.73, 95% CI 0.88-3.38, p=0.113) or overall reconstruction failures (OR 2.09, 95% CI 0.76-5.73, p=0.152). The nomogram model for implant-based reconstruction showed good predictive performance for complication-related reconstruction failures (AUC =0.714).Conclusions PMRT appears to be associated with an increased risk of major complications and complication-related reconstruction failures in patients with implant-based reconstruction.

Telehealth: Could It Be an Avenue to Microvascular Breast Reconstruction for Patients with Geographical Barriers?

Background All women undergoing a mastectomy have the right to reconstruction. However, many women do not receive reconstruction and many more are not aware of all the reconstructive options available to them. Travel distance to a center that provides reconstruction and subsequent follow-up may be a contributing factor to this disparity especially among those who seek microsurgical options. Telehealth, which provides patients with remote video consultations and decreases the travel burden, may be a solution to optimize the accessibility of breast reconstruction for these patients. The purpose of this study was to discuss the efficacy and reliability of telehealth to overcome geographic barriers. Methods Patients who received breast reconstruction and participated in video telehealth visits between February and May 2020 were included in this study. Patient demographics, comorbidities, and clinical outcomes were collected. Video telehealth encounters were reviewed to determine specific concerns and questions discussed during these encounters. Results A total of 235 breast reconstruction surgery patient encounters were recorded for 4 plastic surgeons who offer microsurgical breast reconstruction. Eighty-eight patients (37.4%) were seen as telehealth visits, 20 (22.7%) of which were new patient visits. Eight (9.09%) patients were microsurgical breast reconstruction candidates and 25 (28.4%) were following-up after microsurgical breast reconstruction. The majority of telehealth visits included normally healing wounds in the postoperative patient. Conclusion Telehealth provides an avenue for premastectomy consultation, second opinion visits, and postoperative follow-up for patients who have geographical barriers precluding them from reaching plastic surgeons who perform all types of breast reconstruction.

Analysis of patient satisfaction and donor-site morbidity after different types of breast reconstruction

Background and Aims: Breast reconstruction has been shown to improve quality of life. However, factors involved in long-term patient satisfaction are largely unknown. Our aim was to evaluate patient satisfaction and donor-site morbidity in five types of breast reconstruction. Material and Methods: A prospectively collected database of all breast surgery patients at Hospital Rudolfstiftung, Vienna, Austria, was searched for five types of breast reconstruction (2000–2006): implant, latissimus dorsi-flap, latissimus dorsi-flap with implant, free transverse rectus abdominis musculocutaneous-flap, and deep inferior epigastric perforator-flap. Patients were sent a study-specific questionnaire to assess satisfaction. Short-form 36-item health survey was used to analyze (quality of life), and complication data were retrieved from the database and assessed during a follow-up visit. Results: There were 257 patients identified, of whom, 126 responded to the survey (17 implant, 5 latissimus dorsi + implant, 64 latissimus dorsi, 22 transverse rectus abdominis musculocutaneous, and 18 deep inferior epigastric perforator reconstructions). No statistical differences were found in complication or reoperation rates. Deep inferior epigastric perforator–flap patients were significantly more satisfied compared to patients from the implant group ( p = 0.007). However, there was no significant difference regarding quality of life scores among the groups. After logistic regression analysis, only “impairment on daily life” showed to be independently correlated with patient satisfaction. This contrary to both operation type and complication rate which did not correlate with patient satisfaction. Conclusions: Our results indicate that operation type, complication rate, and revision rate did not independently correlate with patient satisfaction. Therefore, to further improve patient satisfaction, future research should be focused on other pro-operative factors, for example, patient education, expectations, and personality characteristics.