Diminishing relative contraindications for immediate breast reconstruction: A multicenter study Journal Article
| Authors: | Albornoz, C. R.; Cordeiro, P. G.; Pusic, A. L.; McCarthy, C. M.; Mehrara, B. J.; Disa, J. J.; Matros, E. |
| Article Title: | Diminishing relative contraindications for immediate breast reconstruction: A multicenter study |
| Abstract: | Background During the past decade, there has been a rise in US breast reconstruction rates, with a greater expansion in prosthetic-based techniques relative to autologous transfer. Immediate reconstruction in high-risk oncologic and surgical patients might be a contributing factor to these trends. Study Design The National Cancer Data Base from the American College of Surgeons and the American Cancer Society was used to identify a breast cancer cohort (1998 to 2011) treated with mastectomy. The patients were divided into high risk and low risk based on presence or absence of historic surgical or oncologic relative contraindications. Reconstructions were categorized as either autologous or implants. To understand trends for each high-risk characteristic, rates were adjusted by 1,000 total mastectomies performed for patients within each specific group and analyzed with Poisson regression. Results Information from 1,040,088 patients with mastectomy was included. Rates of high-risk features did not change from 1998 to 2011. The increase in immediate reconstruction rates was greater for high-risk than low-risk patients (incidence rate ratio = 1.09 vs 1.06; p < 0.05 for both). There was a greater rate increase in implant than autologous reconstructions for both high-risk and low-risk groups. For high-risk patients, implant use increased for all features, but with the greatest change for elderly, comorbidities, and post-mastectomy radiotherapy (p < 0.01). For high-risk patients, autologous tissue use increased significantly for all features except pre-mastectomy radiotherapy. Conclusions Breast reconstruction increased in high-risk surgical and oncologic patients, suggestive of a diminishing set of relative contraindications. Increased implant use in high-risk patients might be a contributing factor toward the preferential national expansion of prosthetic techniques. |
| Keywords: | controlled study; treatment outcome; aged; cancer surgery; retrospective studies; major clinical study; advanced cancer; multimodality cancer therapy; united states; cancer radiotherapy; postoperative care; follow up; methodology; follow-up studies; breast cancer; mastectomy; risk factors; breast neoplasms; breast reconstruction; mammaplasty; retrospective study; risk factor; high risk patient; time; time factors; risk assessment; postoperative complication; postoperative complications; medical information; multicenter study; breast tumor; surgical risk; comorbidity; outcome and process assessment (health care); breast implants; treatment contraindication; drug contraindication; non profit organization; surgical patient; autotransplantation; preoperative radiotherapy; low risk patient; breast implant; humans; human; female; article |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 219 |
| Issue: | 4 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2014-10-01 |
| Start Page: | 788 |
| End Page: | 795 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2014.05.012 |
| PUBMED: | 25159019 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 1 December 2014 -- Source: Scopus |
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