Mastectomy Research Today is a free monthly online journal that collates and summarizes the latest research about Mastectomy, including details on breast cancer, prosthesis, recovery, surgery, complications.

Do variations in provider discussions explain socioeconomic disparities in postmastectomy breast reconstruction?

Greenberg CC, Schneider EC, Lipsitz SR, Ko CY, Malin JL, Epstein AM, Weeks JC, Kahn KL

Center for Surgery and Public Health, Division of Surgical Oncology, Brigham and Women's Hospital, Boston, MA 02115, USA.

BACKGROUND: The use of postmastectomy reconstruction varies with socioeconomic status, but the etiology of these variations is not understood. We investigated whether these differences reflect variations in the rate or qualitative aspects of the provider's discussion of reconstruction as an option. STUDY DESIGN: Data were collected through chart review and patient survey for stages I to III breast cancer patients during the National Initiative on Cancer Care Quality. Multivariable logistic regression was used to identify predictors of reconstruction and discussion of reconstruction as an option. Predictors of not receiving reconstruction despite a documented discussion were also determined. RESULTS: There were 253 of 626 patients who received reconstruction (40.4%). Younger, more educated Caucasian women who were not overweight or receiving postmastectomy radiation were more likely to receive reconstruction. Patients who were younger, more educated, and not receiving postmastectomy radiation were more likely to have a documented discussion of reconstruction. If a discussion was documented, patients who were older, Hispanic, not born in the US, and received postmastectomy radiation were less likely to receive reconstruction. The greatest predictor of reconstruction was medical record documentation of a discussion about reconstruction. CONCLUSIONS: We observed disparities in the likelihood of reconstruction that were at least partially explained by differences in the likelihood that reconstruction was discussed. But there were also differences in the likelihood of reconstruction based on age, race, and radiation once discussions occurred. Efforts to increase and improve discussions about reconstruction may decrease disparities for this procedure.

Published 4 April 2008 in J Am Coll Surg, 206(4): 605-15.
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Articles on Mastectomy published 28 March 2008:

Hyperglycemia as a risk factor for surgical site infections in patients undergoing mastectomy.   Am J Infect Control, 36(3): 192-8.

BACKGROUND: The aim of this study was to evaluate the association between perioperative hyperglycemia and surgical site infections (SSIs) in patients undergoing mastectomy. METHODS: In this nested case-control study, patients undergoing mastectomy from May 2004 to June 2006, at the National Cancer Institute (INCan), Mexico, were included. Five blood glucose values were obtained for each patient. Patients were followed prospectively by direct observation for at least 30 days. RESULTS: A total of ... [Abstract] [Full-text]

Articles on Mastectomy published 27 March 2008:

Clinical impact of oncoplastic surgery in a specialist breast practice.   ANZ J Surg, 78(4): 269-72.

BACKGROUND: Oncoplastic breast surgery is an integral and fundamental component of the clinical management of breast cancer. The aim of this study was to determine the proportion of oncoplastic and reconstructive breast cancer procedures undertaken within a specialist breast practice. METHODS: An audit of breast-related cancer procedures was undertaken for patients with early breast cancer between 1 January 2001 and 31 December 2005, treated at the Royal Adelaide Hospital and in private ... [Abstract] [Full-text]

Articles on Mastectomy published 26 March 2008:

The impact of a false-positive MRI on the choice for mastectomy in BRCA mutation carriers is limited.   Ann Oncol, 19(4): 655-9.

PURPOSE: To assess the false-positive rate of breast cancer surveillance by magnetic resonance imaging (MRI) in BRCA mutation carriers and the impact of an abnormal mammography or breast MRI on the patients' decision for prophylactic mastectomy. PATIENTS AND METHODS: A total of 196 BRCA mutation carriers were included with a median follow-up of 2 years (range 1-9) with annual mammography and MRI. Preference for prophylactic mastectomy was registered at first surveillance after the mutation ... [Abstract] [Full-text]

Articles on Mastectomy published 19 March 2008:

Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: the Danish Breast Cancer Cooperative Group.   J Clin Oncol, 26(9): 1419-26.

PURPOSE: To examine the importance of estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER-2), and constructed subtypes in a large study randomly assigning patients to receive or not receive postmastectomy radiotherapy (PMRT). PATIENTS AND METHODS: The present analysis included 1,000 of the 3,083 high-risk breast cancer patients randomly assigned to PMRT in the Danish Breast Cancer Cooperative Group (DBCG) protocol 82 trials b and c. Tissue ... [Abstract] [Full-text]

Articles on Mastectomy published 11 March 2008:

Outpatient mastectomy and breast reconstructive surgery.   Ann Surg Oncol, 15(4): 1032-9.

BACKGROUND: In the United States, post-mastectomy breast reconstruction is a state (all 51 jurisdictions) and federally mandated benefit. Outpatient mastectomy, which could lower use of breast reconstruction, may raise concerns about whether patients receive adequate post-mastectomy care. METHODS: Using linked surveillance, epidemiology, and end results (SEER)-Medicare data, we identified Medicare fee-for-service women aged 65-69 years, diagnosed with early-stage breast cancer, and receiving ... [Abstract] [Full-text]

Articles on Mastectomy published 6 March 2008:

Postoperative sense of well-being and quality of life in breast cancer patients do not depend on type of primary surgery.   Onkologie, 31(3): 99-104.

BACKGROUND: In primary breast cancer, breast conserving surgery and mastectomy are equal options with regard to patient survival. We therefore investigated whether and how the type of surgery has impact on the patients' quality of life (QoL) in order to support individualized surgical concepts in treatment of breast cancer. 3 types of surgery are compared: breast-conserving surgery; modified radical mastectomy with or without primary reconstruction. PATIENTS AND METHODS: 91 out of 114 ... [Abstract] [Full-text]

Articles on Mastectomy published 4 March 2008:

Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm.   Plast Reconstr Surg, 121(3): 849-59.

BACKGROUND: In female-to-male transsexuals, the first surgical procedure in their reassignment surgery consists of the subcutaneous mastectomy. The goals of subcutaneous mastectomy are removal of breast tissue, removal of excess skin, reduction and proper positioning of the nipple and areola, and ideally, minimization of chest-wall scars. The authors present the largest series to date of female-to-male transsexuals who have undergone subcutaneous mastectomy. METHODS: A total of 184 subcutaneous ... [Abstract] [Full-text]

Assessment of immediate conservative breast surgery reconstruction: a classification system of defects revisited and an algorithm for selecting the appropriate technique.   Plast Reconstr Surg, 121(3): 716-27.

BACKGROUND: Although various techniques have been used for breast conservation surgery reconstruction, there are few studies describing a logical approach to reconstruction of these defects. The objectives of this study were to establish a classification system for partial breast defects and to develop a reconstructive algorithm. METHODS: The authors reviewed a 7-year experience with 209 immediate breast conservation surgery reconstructions. Mean follow-up was 31 months. Type I defects include ... [Abstract] [Full-text]

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