Our Jacksonville breast reconstruction practice continues to offer the latest in reconstructive options. Please read this excerpt from the breast journal.
The study by Nedumpara et al is an important contribution. They describe oncologic outcomes of 691 patients who underwent mastectomy over an 11 year period. With a median follow-up of 55 months, local and systemic recurrence risks and deaths were comparable in patients with and without immediate breast reconstruction. Quality-of-life comparison and surgical complications were not discussed in this study.
Over the ensuing decades, surgical techniques advanced allowing many patients to undergo skin-sparing, and more recently, nipple-sparing mastectomy with immediate implant or autologous tissue reconstruction. Numerous prior studies have demonstrated comparable low recurrence risks in appropriately selected patients. Nedumpara et al’s important study adds to this literature.
There is a wide variation (15%-85%) in immediate breast reconstruction rates at hospitals nationally and internationally. The reasons for this are complex but include insurance coverage, patient education, and availability of plastic reconstructive expertise. There are clear apparent advantages to immediate reconstruction including preservation of normal breast shape with skin-sparing and nipple-sparing techniques and maintenance of normal body appearance. This can have a profound impact on breast cancer patients regaining an excellent quality of life after breast cancer treatment.
A recently published study by Heneghan et al (Eur J Surg Oncol 2011;37:937-943, PMID: 21899982) demonstrated a comparable quality of life for patients who underwent skin-sparing mastectomy with reconstruction compared with patients who had breast-conservation surgery. Measuring patient satisfaction is critical to understanding quality-of-life outcomes in addition to the usual oncologic end points. This has led to the development of the BREAST-Q patient-reported outcome measure (Plast Reconstr Surg 2009;124:345-353, PMID: 19644246).
The importance of the breast reconstruction issue resulted in the passage of a law (A10094B/S6993-B/Information and Access to Breast Reconstruction Surgery) in New York in August 2011. This law requires hospitals to inform breast cancer patients about the availability of and insurance coverage for reconstruction before they undergo mastectomy. Continued studies such as this one by Nedumpara et al will help to remove any concerns that oncology safety is a reason for a patient to not undergo immediate breast reconstruction.