Annelotte C M van Bommel, Kay Schreuder1, Renske K Veenstra2, Kelly M de Ligt1, Marie-Jeanne T F D Vrancken Peeters3, John H Maduro4, Sabine Siesling, Marc A M Mureau. 1. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands. 2. Department of Operations, Medical Research Data Management, Leeuwenbrug 115, 7411 TH, Deventer, The Netherlands. 3. Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. 4. Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Abstract
BACKGROUND: Immediate breast reconstruction (IBR) may improve quality of life of patients receiving mastectomy. However, a significant hospital variation exists in the use of IBR due to various reasons. To better understand this variation, the present study investigated preoperative information provision to patients and personal opinions of surgical oncologists and plastic surgeons towards potential contra-indications for IBR. METHODS: An online survey (35 questions) was developed including questions on respondent demographics, information provision to the patient about IBR and potential contra-indications by IBR technique. RESULTS: One-hundred-eighty-nine physicians participated: 118 surgical oncologists and 71 plastic surgeons. All clinicians discussed the possibility of IBR with their patients. Complications (79% versus 100%, P < 0.001) and aesthetic outcomes (83% versus 99%, P = 0.001) were discussed less frequently by surgical oncologists than by plastic surgeons.Patient age >75 years, breast size >D-cup, BMI >40 kg/m, smoking (for implant reconstruction), pulmonary/cardiac comorbidities (for autologous reconstruction) and radiotherapy were considered a contra-indication more frequently by plastic surgeons. In contrast, surgical oncologists reported tumor stage (≥cT3), nodal stage (≥cN2) and chemotherapy more frequently to be a contra-indication for IBR. CONCLUSION: We observed that all respondents discussed the possibility of IBR with their patients, whereas patient-tailored information was given more frequently by plastic surgeons. Physicians differed in their opinions towards contra-indications for IBR, with plastic surgeons reporting patient-related risk factors for wound healing problems and surgical oncologists reporting oncological contra-indications more frequently. Consensus between physicians regarding contra-indications for IBR may optimize patient counseling and shared decision-making.
BACKGROUND: Immediate breast reconstruction (IBR) may improve quality of life of patients receiving mastectomy. However, a significant hospital variation exists in the use of IBR due to various reasons. To better understand this variation, the present study investigated preoperative information provision to patients and personal opinions of surgical oncologists and plastic surgeons towards potential contra-indications for IBR. METHODS: An online survey (35 questions) was developed including questions on respondent demographics, information provision to the patient about IBR and potential contra-indications by IBR technique. RESULTS: One-hundred-eighty-nine physicians participated: 118 surgical oncologists and 71 plastic surgeons. All clinicians discussed the possibility of IBR with their patients. Complications (79% versus 100%, P < 0.001) and aesthetic outcomes (83% versus 99%, P = 0.001) were discussed less frequently by surgical oncologists than by plastic surgeons.Patient age >75 years, breast size >D-cup, BMI >40 kg/m, smoking (for implant reconstruction), pulmonary/cardiac comorbidities (for autologous reconstruction) and radiotherapy were considered a contra-indication more frequently by plastic surgeons. In contrast, surgical oncologists reported tumor stage (≥cT3), nodal stage (≥cN2) and chemotherapy more frequently to be a contra-indication for IBR. CONCLUSION: We observed that all respondents discussed the possibility of IBR with their patients, whereas patient-tailored information was given more frequently by plastic surgeons. Physicians differed in their opinions towards contra-indications for IBR, with plastic surgeons reporting patient-related risk factors for wound healing problems and surgical oncologists reporting oncological contra-indications more frequently. Consensus between physicians regarding contra-indications for IBR may optimize patient counseling and shared decision-making.
Authors: E Heeg; M B Jensen; M A M Mureau; B Ejlertsen; R A E M Tollenaar; P M Christiansen; M T F D Vrancken Peeters Journal: Breast Cancer Res Treat Date: 2020-06-10 Impact factor: 4.872
Authors: L S E van Egdom; K M de Ligt; L de Munck; L B Koppert; M A M Mureau; H A Rakhorst; S Siesling Journal: Breast Cancer Date: 2021-11-15 Impact factor: 4.239