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A worrying lump
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Many women are devastated by the thought of mastectomy. Discussing the possibility of breast reconstruction surgery can help. The decision to advise breast conservation surgery or mastectomy depends on many factors including the ratio of the size of the tumour to the size of the breast, the pathological features of the tumour (e.g. multiple sites), the age of the patient, the patient’s general health, and the patient’s preferences.
Breast Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Gaural Patel, Lucy Kate Satherley, Animesh JK Patel, Georgina SA Phillips
Breast reconstruction can be immediate, delayed or ‘delayed-immediate’ in relation to the timing of the mastectomy: Immediate: takes place at the same time as the mastectomy.Delayed: takes place some time after the mastectomy, usually after any adjuvant treatment has been completed.Delayed-immediate: performed when a patient wishes to have an autologous reconstruction but cannot or does not wish to have it at the time of the mastectomy. A temporary tissue expander is placed to preserve the skin envelope, allowing for a more aesthetic reconstruction later.
Reconstructive perspectives
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
Breast reconstruction is an option for all patients undergoing mastectomy. Nonetheless the best technique varies based on individual patient preferences, comorbidities, and cancer biology. Treatment delays are best avoided by ensuring early discussion of breast reconstruction risks and benefits. This should involve multidisciplinary input from surgical, medical, and radiation oncologists, as well as reconstruction surgeons. Through coordinated multidisciplinary care, breast and plastic surgeons can work together to improve cosmetic outcomes without sacrificing the quality of cancer treatment provided.
The evolution of breast reconstructions with free flaps: a historical overview
Published in Acta Chirurgica Belgica, 2023
Filip E. F. Thiessen, Nicolas Vermeersch, Thierry Tondu, Veronique Verhoeven, Lawek Bersenji, Yves Sinove, Guy Hubens, Gunther Steenackers, Wiebren A. A. Tjalma
Breast cancer is the most common cancer in women worldwide [1]. In 2018, there were over 2 million cases. Belgium is the country with the highest rate of breast cancer in the world (113/100.000). The five years survival in Belgium is 83%, which is equal to the average five year survival for breast cancer in Europe (82%) [2]. The keystones in breast cancer treatment are patient’s survival and minimizing treatment’s morbidity. Approximately 40% of the patients with breast cancer undergoes a mastectomy. Breast amputation is a lifesaving but mutilating procedure. Therefore a good quality of life and a good cosmetic outcome is mandatory after cancer surgery [3]. Reconstructive breast surgery aims to recreate a natural looking breast that is warm to touch [4]. The chosen technique, either implant-based or autologous breast reconstruction, depends on the physiognomy of the patient, technical skills of the surgical team and most important the expectations of the patient.
Validation and reliability testing of the BREAST-Q expectations questionnaire in Swedish
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Linn Weick, Anna Grimby-Ekman, Carolina Lunde, Emma Hansson
A breast reconstruction is a patient-chosen adjunct in breast cancer treatment. As a breast reconstruction is something the woman chooses to have herself, it is performed primarily to enhance quality of life and she invests time, discomfort and recovery efforts to have it, it can be assumed that expectations in general are high. Hence, it would be expected that more women reach the threshold for the ceiling effect, than for the floor effect (Table 9). Nonetheless, the high number of women reaching the ceiling threshold is suboptimal if the instrument is going to be used to identify patients with unrealistic expectations [15]. The high levels of ceiling effect (Table 9) could be an indication that there should be more items to enable the instrument to discriminate between high expectations and too high, unrealistic, expectations. More studies are needed on how we can evaluate if expectations are realistic or not.
The effect of implant loss after immediate breast reconstruction on patient satisfaction with outcome and quality of life after five years – a case-control study
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Linn Weick, Carolina Lunde, Emma Hansson
Breast reconstruction can either be performed at the time of mastectomy (immediate breast reconstruction – IBR) or in a separate later operation (delayed breast reconstruction – DBR). In Sweden, about 2–30% of patients who undergo mastectomy have IBR, depending on geographic location [1]. Several advantages have been suggested for IBR, such as cost-effectiveness, better quality of life (QoL), psychosocial benefits and better aesthetic outcome [2]; although, the scientific high-quality evidence confirming these positive outcomes is limited [3–5]. Several studies have suggested that, after a few years, QoL and psychosocial function are similar for women who have had IBR and DBR [2,3,5–7]. Disadvantages of IBR, compared to DBR, include an increased risk for complications [3,5]. The most significant complication after breast reconstruction is reconstructive failure, that is implant loss or flap loss. The prevalence of implant loss has been reported to be around 5–10% in IBR compared to 1% in DBR [3,8,9]. The risk for implant loss is one important factor to consider when making the choice between IBR and DBR. However, little is known on how women experience implant loss and its association with patient satisfaction and QoL.