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Yu L, Gong J, Sun X, Zang M, Liu L, Yu S. Assessing the Content and Effect of Web-Based Decision Aids for Postmastectomy Breast Reconstruction: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Med Internet Res 2024; 26:e53872. [PMID: 38801766 PMCID: PMC11165285 DOI: 10.2196/53872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast reconstruction (PMBR). However, the existing findings regarding these interventions are still incongruent, and the overall effect is unclear. OBJECTIVE We aimed to assess the content of web-based decision aids and its impact on decision-related outcomes (ie, decision conflict, decision regret, informed choice, and knowledge), psychological-related outcomes (ie, satisfaction and anxiety), and surgical decision-making in women facing PMBR. METHODS This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 6 databases, PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science Core Collection, were searched starting at the time of establishment of the databases to May 2023, and an updated search was conducted on April 1, 2024. MeSH (Medical Subject Headings) terms and text words were used. The Cochrane Risk of Bias Tool for randomized controlled trials was used to assess the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS In total, 7 studies included 579 women and were published between 2008 and 2023, and the sample size in each study ranged from 26 to 222. The results showed that web-based decision aids used audio and video to present the pros and cons of PMBR versus no PMBR, implants versus flaps, and immediate versus delayed PMBR and the appearance and feel of the PMBR results and the expected recovery time with photographs of actual patients. Web-based decision aids help improve PMBR knowledge, decisional conflict (mean difference [MD]=-5.43, 95% CI -8.87 to -1.99; P=.002), and satisfaction (standardized MD=0.48, 95% CI 0.00 to 0.95; P=.05) but have no effect on informed choice (MD=-2.80, 95% CI -8.54 to 2.94; P=.34), decision regret (MD=-1.55, 95% CI -6.00 to 2.90 P=.49), or anxiety (standardized MD=0.04, 95% CI -0.50 to 0.58; P=.88). The overall Grading of Recommendations, Assessment, Development, and Evaluation quality of the evidence was low. CONCLUSIONS The findings suggest that the web-based decision aids provide a modern, low-cost, and high dissemination rate effective method to promote the improved quality of decision-making in women undergoing PMBR. TRIAL REGISTRATION PROSPERO CRD42023450496; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450496.
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Affiliation(s)
- Lin Yu
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, China
| | - Jianmei Gong
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, China
| | - Xiaoting Sun
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, China
| | - Min Zang
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, China
| | - Lei Liu
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, China
| | - Shengmiao Yu
- Outpatient Department, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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Berger O, Talisman R. Histologic Examination of Mastectomy Scars during Breast Reconstruction: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5847. [PMID: 38798931 PMCID: PMC11124693 DOI: 10.1097/gox.0000000000005847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/08/2024] [Indexed: 05/29/2024]
Abstract
Background Breast reconstruction is a standard procedure in postmastectomy plastic surgery. The necessity of routine histological examinations for mastectomy scars during delayed reconstruction remains a topic of debate. We evaluated the need for histological examination of scars during delayed breast reconstruction. Methods We conducted a systematic review using PubMed, TDnet, and Cochrane Central in August 2023. Inclusion criteria involved delayed breast reconstruction with histological scar analysis and malignancy reporting. Exclusion criteria encompassed noncancerous breast diseases, prophylactic mastectomies, articles lacking relevant information, case reports, technique descriptions, and reviews. We independently assessed articles. Differences in recurrence rates were determined using a Z-test for proportions. A linear regression model explored the relationship between reconstruction timing and pathological results. The number needed to treat was calculated based on the literature. The Wilcoxon test was used to compare mean reconstruction times and postreconstruction follow-up between groups. Results Our analysis covered 11 retrospective observational studies published between 2003 and 2018, including 3754 mastectomy scars. The malignancy recurrence rate was 0.19%, consistent with previous reports, with a number needed to treat of 144.93-188.68 patients. The timing of breast reconstruction postmastectomy averaged 19.9 months, without statistically significant association between reconstruction timing and recurrence rates. Postreconstruction follow-up periods ranged from 60 to 87 months. The postreconstruction adverse outcomes ratio was 2.21%. Conclusions Assessing the necessity of histological examination in breast reconstruction is complex. Based on the literature and this study, we do not recommend routine histological examination of mastectomy scars during delayed reconstruction. A selective approach based on risk factors may be beneficial, warranting further research.
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Affiliation(s)
- Ori Berger
- From The Plastic Surgery Unit, Barzilai University Hospital Medical Center, Ashkelon, Israel
| | - Ran Talisman
- From The Plastic Surgery Unit, Barzilai University Hospital Medical Center, Ashkelon, Israel
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Li Y, Wang Y, Wang Y, Zhao L, Gan J. A Retrospective Case-Control Study Evaluating Effects of Beck's Cognitive Therapy on Anxiety in Patients after Breast Reconstruction. ALPHA PSYCHIATRY 2024; 25:40-46. [PMID: 38799483 PMCID: PMC11114150 DOI: 10.5152/alphapsychiatry.2024.231303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/04/2023] [Indexed: 05/29/2024]
Abstract
Objective To explore the effects of Beck's cognitive therapy on the anxiety of patients after breast reconstruction. Methods This study retrospectively analyzed clinical data of 150 patients with breast cancer undergoing breast reconstruction from June 2020 to June 2021 in our hospital, excluded 5 patients who did not meet the inclusion criteria, divided the remaining cases into an experimental group (EG, n = 70, perioperative routine management + Beck's cognitive therapy intervention) and a reference group (RG, n = 75, perioperative routine management) in accordance with different perioperative intervention programs, and compared the emotions of anxiety and depression, sense of social disability, and prognosis quality in both groups. Results At 2 months after surgery (T2) and 3 months after surgery (T3), EG had overtly lower Hamilton Anxiety Scale (HAMA) and Beck Depression Inventory (BDI) scores than RG (P < .05), with no difference in HAMA and BDI scores at 3 days before surgery (T0) and 1 month after surgery (T1) (P > .05). At the T0 stage, both groups were diagnosed as having a social disability, with no overt difference (P > .05). At T1 stage, The Social Disability Screening Schedule (SDSS) scores in both groups increased remarkably and fell back at the T2 and T3 stages. At T1-T2 stages, SDSS scores of EG were significantly different from those of RG (P < .05), with no significant difference at T3 stage (P > .05). The excellent rate of prognosis in EG was 78.57% (55/70), higher than 77.33% (58/75) in RG, with no statistical difference in both groups (P < .05). Conclusion The implementation of Beck's cognitive therapy in patients with breast reconstruction effectively improves adverse emotions in patients, which is of great significance for promoting postoperative rehabilitation and is an effective intervention program in the perioperative period.
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Affiliation(s)
- Yan Li
- Department of Surgery and Anesthesiology, Tangshan People’s Hospital, Hebei, China
| | - Yu Wang
- Department of Surgery and Anesthesiology, Tangshan People’s Hospital, Hebei, China
| | - Yaqi Wang
- Department of Surgical Oncology, Tangshan People’s Hospital, Hebei, China
| | - Leyuan Zhao
- Department of Surgery and Anesthesiology, Tangshan People’s Hospital, Hebei, China
| | - Jianhui Gan
- Department of Anesthesia, Tangshan People’s Hospital, Hebei, China
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Kanavou T, Mastorakos DP, Mastorakos PD, Faliakou EC, Athanasiou A. Imaging of the Reconstructed Breast. Diagnostics (Basel) 2023; 13:3186. [PMID: 37892007 PMCID: PMC10605380 DOI: 10.3390/diagnostics13203186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
The incidence of breast cancer and, therefore, the need for breast reconstruction are expected to increase. The many reconstructive options available and the changing aspects of the field make this a complex area of plastic surgery, requiring knowledge and expertise. Two major types of breast reconstruction can be distinguished: breast implants and autologous flaps. Both present advantages and disadvantages. Autologous fat grafting is also commonly used. MRI is the modality of choice for evaluating breast reconstruction. Knowledge of the type of reconstruction is preferable to provide the maximum amount of pertinent information and avoid false positives. Early complications include seroma, hematoma, and infection. Late complications depend on the type of reconstruction. Implant rupture and implant capsular contracture are frequently encountered. Depending on the implant type, specific MRI signs can be depicted. In the case of myocutaneous flap, fat necrosis, fibrosis, and vascular compromise represent the most common complications. Late cancer recurrence is much less common. Rarely reported late complications include breast-implant-associated large cell anaplastic lymphoma (BIA-ALCL) and, recently described and even rarer, breast-implant-associated squamous cell carcinoma (BIA-SCC). In this review article, the various types of breast reconstruction will be presented, with emphasis on pertinent imaging findings and complications.
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Affiliation(s)
| | - Dimitrios P Mastorakos
- 2nd Breast Surgery Unit, Mitera Hospital, 15123 Athens, Greece
- Athens Breast Clinic, 11527 Athens, Greece
| | | | - Eleni C Faliakou
- 2nd Breast Surgery Unit, Mitera Hospital, 15123 Athens, Greece
- Athens Breast Clinic, 11527 Athens, Greece
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Torres S, Peleteiro B, Magalhães A, Garrido L, Costa S, Fougo JL. Differences among a Portuguese cohort of BRCA pathogenic/likely pathogenic variants carriers choosing risk-reducing mastectomy or intensive breast surveillance. J Cancer Res Clin Oncol 2023; 149:7529-7538. [PMID: 36971799 PMCID: PMC10374730 DOI: 10.1007/s00432-023-04663-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Women with BRCA1 and BRCA2 (BRCA1/2) pathogenic/likely pathogenic (P/LP) variants have a higher risk to develop breast and ovarian cancer. In structured high-risk clinics, risk-reducing measures are adopted. This study aimed at characterizing these women and identify factors that may have influenced their choice between risk reduction mastectomy (RRM) and intensive breast surveillance (IBS). METHODS This study reviewed retrospectively 187 clinical records of affected and unaffected women with P/LP variants of the BRCA1/2 genes, from 2007 to 2022, of which 50 chose RRM, while 137 chose IBS. The research focused on personal and family history and tumor characteristics and their relation with the preventive option chosen. RESULTS Among women with personal history of breast cancer, a higher proportion opted for RRM compared to those asymptomatic (34.2% vs 21.3%, p = 0.049), with younger age determining the option for RRM (38.5 years vs 44.0 years, p < 0.001). Among women with personal history of ovarian cancer, a higher proportion opted for RRM compared to those without that history (62.5% vs 25.1%, p = 0.033), with younger age determining the option for RRM (42.6 years vs 62.7 years, p = 0.009). Women who had bilateral salpingo-oophorectomy were more likely to choose RRM than those who did not (37.3% vs 18.3%, p = 0.003). Family history was not associated with preventive option (33.3% vs 25.3, p = 0.346). CONCLUSIONS The decision for the preventive option is multifactorial. In our study, personal history of breast or ovarian cancer, younger age at diagnosis, and previous bilateral salpingo-oophorectomy were associated with the choice of RRM. Family history was not associated with the preventive option.
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Affiliation(s)
- Sandra Torres
- Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal.
| | - Bárbara Peleteiro
- Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
- Breast Center, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal
- EPI Unit, Institute of Public Health, University of Porto, 4050-600, Porto, Portugal
- Laboratory for Integrative and Translation Research in Population Health, University of Porto, 4050-600, Porto, Portugal
| | - André Magalhães
- Breast Center, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal
| | - Luzia Garrido
- Breast Center, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal
- Medical Genetics Service, Centro Hospitalar e Universitário São João, 4200-319, Porto, Portugal
| | - Susy Costa
- Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
- Breast Center, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal
| | - José Luís Fougo
- Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
- Breast Center, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal
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Wignarajah P, Malata CM, Benson JR. Oncoplastic and reconstructive breast surgery. Front Oncol 2023; 13:1176915. [PMID: 37448512 PMCID: PMC10338173 DOI: 10.3389/fonc.2023.1176915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 07/15/2023] Open
Abstract
This article provides an overview of the principles and techniques of oncoplastic and reconstructive breast surgery for patients with early-stage breast cancer. Oncoplastic breast surgery (OPBS) with partial breast reconstruction is a natural evolution in the application of breast conserving surgery and permits wide surgical resection of tumours that might otherwise mandate mastectomy and whole breast reconstruction. These reconstructive techniques must be optimally selected and integrated with ablative breast surgery together with non-surgical treatments such as radiotherapy and chemotherapy that may be variably sequenced with each other. A multidisciplinary approach with shared decision-making is essential to ensure optimal clinical and patient-reported outcomes that address oncological, aesthetic, functional and psychosocial domains. Future practice of OPBS must incorporate routine audit and comprehensive evaluation of outcomes.
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Affiliation(s)
- Primeera Wignarajah
- Department of Breast Surgery, Royal Marsden Hospital NHS Trust, London, United Kingdom
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Charles M Malata
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Plastic and Reconstructive Surgery, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Anglia Ruskin University School of Medicine, Cambridge/Chelmsford, United Kingdom
| | - John R Benson
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Anglia Ruskin University School of Medicine, Cambridge/Chelmsford, United Kingdom
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Wu S, Ma X, Zhang X, Yang C, Wang Y, Liu Y. Survival outcomes of autologous breast reconstruction after mastectomy: A matched case-control study. Front Oncol 2023; 12:1022925. [PMID: 36686843 PMCID: PMC9853161 DOI: 10.3389/fonc.2022.1022925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Background Due to the lack of strong evidence-based medical evidence, the relationship between autologous breast reconstruction (ABR) after mastectomy and long-term prognosis is unclear. This study aims to explore if ABR after mastectomy is associated with the prognosis of breast cancer (BC) patients based on the data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods We collected data for all cases diagnosed with BC who underwent or did not undergo ABR after mastectomy from 2010-2015 in the SEER database. The primary outcome of our study was overall survival (OS) and cancer specific survival (CSS). The Propensity Score-Matched (PSM) analysis was used to eliminate the effects of non-random statistics, setting the caliper as 0.0001 to balance the baseline variables within the groups. Chi-square test, Kaplan-Meier method, univariate and multivariate cox regression analysis were used to analyze the data and subgroup analysis was performed to find the subgroups of people who might benefit from ABR. Result Of 27893 eligible patients, 11038 patients were matched. The cohort consisted of 5519 (50%) ABR patients and 5519 (50%) non-ABR patients after PSM. After PSM, on multivariate cox regression analysis, ABR still exerted a significant influence on the OS (hazard ratio (HR), 0.83, P< 0.05). However, no statistical difference was shown on CSS (HR, 0.93, P = 0.31). Kaplan-Meier survival analysis showed ABR group had better OS (P = 0.001), but similar CSS (P = 0.174) between ARB and mastectomy groups. Subgroup analysis showed that after matching, those with 50-59 years old, earlier stages of disease, without a marital partner and living in urban areas had better OS after ABR. Conclusions ABR after mastectomy was associated with better OS, but not affect CSS.
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Affiliation(s)
- Shang Wu
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China
| | - Xindi Ma
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China
| | - Xiangmei Zhang
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China
| | - Chao Yang
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China
| | - Yubin Wang
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China
| | - Yunjiang Liu
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China,*Correspondence: Yunjiang Liu,
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Cui W, Xie Y. Oncological results in women with wound complications following mastectomy and immediate breast reconstruction: A meta‐analysis. Int Wound J 2022; 20:1361-1368. [PMID: 36336978 PMCID: PMC10088858 DOI: 10.1111/iwj.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022] Open
Abstract
We performed a meta-analysis to evaluate the oncological results in women with wound complications following mastectomy and immediate breast reconstruction. A systematic literature search up to August 2022 was performed and 1618 subjects with mastectomy and immediate breast reconstruction at the baseline of the studies; 443 of them were with wound complications, and 1175 were with no wound complications as a control. Odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the oncological results in women with wound complications following mastectomy and immediate breast reconstruction using dichotomous or contentious methods with a random or fixed-effect model. The wound complications had a significantly longer length of time to adjuvant therapy (MD, 9.44; 95% CI, 4.07-14.82, P < .001) compared with no wound complications in subjects with mastectomy and immediate breast reconstruction. However, no significant difference was found between wound complications and no wound complications in subjects with mastectomy and immediate breast reconstruction in breast cancer recurrence (OR, 1.96; 95% CI, 0.95-4.06, P = .07), death rates (OR, 1.95; 95% CI, 0.89-4.27, P = .09), and kind of immediate breast reconstruction (OR, 1.01; 95% CI, 0.53-1.92, P = .98). The wound complications had a significantly longer length of time to adjuvant, however, no significant difference was found in breast cancer recurrence, death rates, and kind of immediate breast reconstruction. The analysis of outcomes should be done with caution even though no low sample size was found in the meta-analysis but a low number of studies was found in certain comparisons.
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Affiliation(s)
- Wenting Cui
- Department of Breast Surgery, Huangpu Branch, Ninth People's Hospital Shanghai Jiaotong University School of Medicine Shanghai People's Republic of China
| | - Yiqun Xie
- Department of Breast Surgery, Huangpu Branch, Ninth People's Hospital Shanghai Jiaotong University School of Medicine Shanghai People's Republic of China
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