Ming Lee1, Erik Reinertsen2, Evan McClure3, Shuling Liu4, Laura Kruper5, Neil Tanna6, J Brian Boyd7, Jay W Granzow8. 1. Emory University School of Medicine, Atlanta, GA, USA. 2. Emory University School of Medicine, Atlanta, GA, USA; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA. 3. Emory University School of Medicine, Atlanta, GA, USA; Goizueta Business School, Emory University, Atlanta, GA, USA. 4. Department of Biostatistics, Rollins School of Public Health at Emory University, Atlanta, GA, USA. 5. Division of Surgical Oncology, City of Hope Cancer Center, Los Angeles, CA, USA. 6. Division of Plastic and Reconstructive Surgery, North Shore - LIJ Health System, New York, NY, USA. 7. Harbor-UCLA Medical Center and the UCLA David Geffen School of Medicine, Los Angeles, CA, USA. 8. Harbor-UCLA Medical Center and the UCLA David Geffen School of Medicine, Los Angeles, CA, USA. Electronic address: DrJay@PlasticSurgery.LA.
Abstract
OBJECTIVES: Although postmastectomy radiation therapy (PMRT) has been shown to reduce breast cancer burden and improve survival, PMRT may negatively influence outcomes after reconstruction. The goal of this study was to compare current opinions of plastic and reconstructive surgeons (PRS) and surgical oncologists (SO) regarding the optimal timing of breast reconstruction for patients requiring PMRT. METHODS: Members of the American Society of Plastic Surgeons (ASPS), the American Society of Breast Surgeons (ASBS), and the Society of Surgical Oncology (SSO) were asked to participate in an anonymous web-based survey. Responses were solicited in accordance to the Dillman method, and they were analyzed using standard descriptive statistics. RESULTS: A total of 330 members of the ASPS and 348 members of the ASBS and SSO participated in our survey. PRS and SO differed in patient-payor mix (p < 0.01) and practice setting (p < 0.01), but they did not differ by urban versus rural setting (p = 0.65) or geographic location (p = 0.30). Although PRS favored immediate reconstruction versus SO, overall timing did not significantly differ between the two specialists (p = 0.14). The primary rationale behind delayed breast reconstruction differed significantly between PRS and SO (p < 0.01), with more PRS believing that the reconstructive outcome is significantly and adversely affected by radiation. Both PRS and SO cited "patient-driven desire to have immediate reconstruction" (p = 0.86) as the primary motivation for immediate reconstruction. CONCLUSIONS: Although the optimal timing of reconstruction is controversial between PRS and SO, our study suggests that the timing of reconstruction in PMRT patients is ultimately driven by patient preferences and the desire of PRS to optimize aesthetic outcomes.
OBJECTIVES: Although postmastectomy radiation therapy (PMRT) has been shown to reduce breast cancer burden and improve survival, PMRT may negatively influence outcomes after reconstruction. The goal of this study was to compare current opinions of plastic and reconstructive surgeons (PRS) and surgical oncologists (SO) regarding the optimal timing of breast reconstruction for patients requiring PMRT. METHODS: Members of the American Society of Plastic Surgeons (ASPS), the American Society of Breast Surgeons (ASBS), and the Society of Surgical Oncology (SSO) were asked to participate in an anonymous web-based survey. Responses were solicited in accordance to the Dillman method, and they were analyzed using standard descriptive statistics. RESULTS: A total of 330 members of the ASPS and 348 members of the ASBS and SSO participated in our survey. PRS and SO differed in patient-payor mix (p < 0.01) and practice setting (p < 0.01), but they did not differ by urban versus rural setting (p = 0.65) or geographic location (p = 0.30). Although PRS favored immediate reconstruction versus SO, overall timing did not significantly differ between the two specialists (p = 0.14). The primary rationale behind delayed breast reconstruction differed significantly between PRS and SO (p < 0.01), with more PRS believing that the reconstructive outcome is significantly and adversely affected by radiation. Both PRS and SO cited "patient-driven desire to have immediate reconstruction" (p = 0.86) as the primary motivation for immediate reconstruction. CONCLUSIONS: Although the optimal timing of reconstruction is controversial between PRS and SO, our study suggests that the timing of reconstruction in PMRT patients is ultimately driven by patient preferences and the desire of PRS to optimize aesthetic outcomes.
Keywords:
Breast reconstruction; Current practices; Delayed breast reconstruction; Delayed–immediate breast reconstruction; Immediate breast reconstruction; Postmastectomy radiation therapy
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