Breast Reconstruction After Mastectomy
- Describe your topic.
- Topic: The comparison of breast reconstruction options to treat defects associated with the diagnosis and treatment of breast cancer. Example questions: o For patients undergoing breast reconstruction after mastectomy, does immediate implant-based reconstruction versus delayed implant-based reconstruction result in improved surgical outcomes and patient satisfaction? o For patients who underwent mastectomy and implant-based breast reconstruction, does routine breast cancer imaging or screening versus no screening improve the detection of cancer recurrence, reoperation, or survival? o For patients undergoing mastectomy for the treatment of breast cancer, what is the optimal time for implant-based breast reconstruction (i.e., immediate versus delayed) when radiation treatment is required? o For patients undergoing breast reconstruction after mastectomy, does radiation therapy versus no radiation therapy result in an increase in complications? o For patients undergoing breast reconstruction after mastectomy, does neoadjuvant chemotherapy versus no neoadjuvant chemotherapy result in an increase in complications? o For patients undergoing mastectomy and autologous breast reconstruction, what are the comparative risks and benefits of surgical techniques, i.e., abdominal-based flaps versus Latissimus Dorsi flaps with implant? Population of interest: Adult women undergoing breast reconstruction procedures following mastectomy for the treatment of breast cancer; high-risk patients undergoing breast reconstruction. Interventions: Breast reconstruction with expanders/implants (with or without acellular dermal matrix), types of implants (saline versus silicone); breast reconstruction using autologous tissue from abdominal, buttock, or back regions; fat grafting in breast reconstruction; indications for pre-pectoral prosthesis reconstruction; reconstruction options for previously augmented breasts. Outcomes: Surgical outcomes/adverse events (complications, revision rate, failure rate), anesthetic risk, antibiotic influence, risk of stroke/PE, pain management, patient satisfaction (functional, aesthetic), long-term morbidity, cancer recurrence, survival, cost/resource utilization.
- Describe why this topic is important.
- Every year approximately 106,000 women receive breast reconstruction surgery to treat the defects associated with breast cancer, a 35% increase since the year 2000 (ASPS Plastic Surgery statistics, 2017). As the treatment options for breast cancer continue to improve and evolve, so must the reconstruction options in order to restore a woman’s physical features to resemble the condition prior to diagnosis.
- Tell us why you are suggesting this topic.
- The American Society of Plastic Surgeons develops evidence-based clinical practice guidelines on reconstruction procedures; however, we have limited staffing to keep guidelines current. We are suggesting to provide an evidence update for the 2013 guideline, “Breast Reconstruction with Expanders and Implants” and to provide an evidence summary for multiple unaddressed clinical questions in the guideline project related to autologous breast reconstruction.
- Target Date.
- 2021-01-01
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- The purpose of an updated clinical practice guideline on breast reconstruction is to provide clinicians and patients with recommendations for the most beneficial treatment options post-mastectomy. There are several reconstructive treatment options available to women including using autologous tissue from abdominal, buttock, or back regions, as well as the use of prosthetic implants to restore a natural breast appearance. An updated evidence report may lead to stronger recommendations related to the best care options for women with various considerations. Various gaps in care exist related to radiation and chemotherapy considerations (neoadjuvant/adjuvant), and patients receiving radiation, as well as influence of mastectomy-related outcomes on breast reconstruction.
- How will you or your group use the information from a new evidence report?
- An evidence report would allow us to update our previously published clinical practice guideline related to breast reconstruction with expanders and implants, as well as inform clinical questions related to autologous breast reconstruction options.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- The ASPS convenes work groups for guideline development which include ASPS member surgeons, stakeholder representatives from relevant medical specialty societies, and patient representatives. An evidence report would be used by the work group to update and develop new practice recommendations to be published as freely available clinical practice guidelines.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- In previous clinical practice guidelines related to breast reconstruction the ASPS has collaborated with the American Society of Breast Surgeons, the American College of Radiology, the American Society of Radiation Oncology, the American Society of Clinical Oncology, and various patient advocacy groups who have participated on ASPS panels as stakeholder organizations. We would extend an invitation to all previous participating organizations once again.
- Information About You: (optional)
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- Provide a description of your role or perspective.
- Professional society
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- American Society of Plastic Surgeons
- Please tell us how you heard about the Effective Health Care Program.
- The ASPS has been familiar with the Effective Health Care Program and its creation of evidence reports since its inception in 19
