Permissive breast reconstruction and implant loss. A delicate balance and an ethical challenge.
Association of Breast Surgery ePoster Library. Saunders J. 05/13/19; 257164; P122
Mr. Jason Saunders
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P122
Topic: Oncoplastic and aesthetic surgery
ObjectivesPermissive immediate breast reconstruction can result in higher rates of implant loss. Strategies to reduce implant loss can include denying immediate reconstruction to those with more than one risk factor (high BMI, smoking, diabetes, radiotherapy, chemotherapy and axillary node clearance). In contrast we assessed a permissive policy in Newham, an inner London setting with high levels of socioeconomic deprivation and multiethnicity.MethodRetrospective review of patients receiving immediate breast reconstruction between 2014 and 2015 via assessment of electronic and paper patient notes. Risk factors and outcomes (implant loss) were measured at 3, 12 and 24 months. Results: Nineteen patients were identified as having unilateral immediate implant based reconstruction. Median age 50 ( Range 22-83), median BMI 28.8 (Range 18.7-46) Five (26%) were smokers. Only 2 had a single comorbidity( 10.5%). Seventeen (89.5%) had more than one comorbidity.Thirteen (67%) had an axillary node clearance, four ( 21%) received neoadjuvant chemotherapy (NACT) and 12 (63%) received adjuvant chemotherapy. Ten patients (52%) received adjuvant radiotherapy (RT).One had implant loss at 3 months ( 5%) The number of implant failures at 1 year was 4 (21%) and at 2 years was 5 (26%).ConclusionImplant loss at 3 months is at an acceptable limit but loss at 1 year is high. However, this is in a cohort of patients in whom many units would have denied them any immediate reconstruction. Hence the ethical dilemma. At what cost is a unit's figures against those of the individual patient?
Topic: Oncoplastic and aesthetic surgery
ObjectivesPermissive immediate breast reconstruction can result in higher rates of implant loss. Strategies to reduce implant loss can include denying immediate reconstruction to those with more than one risk factor (high BMI, smoking, diabetes, radiotherapy, chemotherapy and axillary node clearance). In contrast we assessed a permissive policy in Newham, an inner London setting with high levels of socioeconomic deprivation and multiethnicity.MethodRetrospective review of patients receiving immediate breast reconstruction between 2014 and 2015 via assessment of electronic and paper patient notes. Risk factors and outcomes (implant loss) were measured at 3, 12 and 24 months. Results: Nineteen patients were identified as having unilateral immediate implant based reconstruction. Median age 50 ( Range 22-83), median BMI 28.8 (Range 18.7-46) Five (26%) were smokers. Only 2 had a single comorbidity( 10.5%). Seventeen (89.5%) had more than one comorbidity.Thirteen (67%) had an axillary node clearance, four ( 21%) received neoadjuvant chemotherapy (NACT) and 12 (63%) received adjuvant chemotherapy. Ten patients (52%) received adjuvant radiotherapy (RT).One had implant loss at 3 months ( 5%) The number of implant failures at 1 year was 4 (21%) and at 2 years was 5 (26%).ConclusionImplant loss at 3 months is at an acceptable limit but loss at 1 year is high. However, this is in a cohort of patients in whom many units would have denied them any immediate reconstruction. Hence the ethical dilemma. At what cost is a unit's figures against those of the individual patient?
P122
Topic: Oncoplastic and aesthetic surgery
ObjectivesPermissive immediate breast reconstruction can result in higher rates of implant loss. Strategies to reduce implant loss can include denying immediate reconstruction to those with more than one risk factor (high BMI, smoking, diabetes, radiotherapy, chemotherapy and axillary node clearance). In contrast we assessed a permissive policy in Newham, an inner London setting with high levels of socioeconomic deprivation and multiethnicity.MethodRetrospective review of patients receiving immediate breast reconstruction between 2014 and 2015 via assessment of electronic and paper patient notes. Risk factors and outcomes (implant loss) were measured at 3, 12 and 24 months. Results: Nineteen patients were identified as having unilateral immediate implant based reconstruction. Median age 50 ( Range 22-83), median BMI 28.8 (Range 18.7-46) Five (26%) were smokers. Only 2 had a single comorbidity( 10.5%). Seventeen (89.5%) had more than one comorbidity.Thirteen (67%) had an axillary node clearance, four ( 21%) received neoadjuvant chemotherapy (NACT) and 12 (63%) received adjuvant chemotherapy. Ten patients (52%) received adjuvant radiotherapy (RT).One had implant loss at 3 months ( 5%) The number of implant failures at 1 year was 4 (21%) and at 2 years was 5 (26%).ConclusionImplant loss at 3 months is at an acceptable limit but loss at 1 year is high. However, this is in a cohort of patients in whom many units would have denied them any immediate reconstruction. Hence the ethical dilemma. At what cost is a unit's figures against those of the individual patient?
Topic: Oncoplastic and aesthetic surgery
ObjectivesPermissive immediate breast reconstruction can result in higher rates of implant loss. Strategies to reduce implant loss can include denying immediate reconstruction to those with more than one risk factor (high BMI, smoking, diabetes, radiotherapy, chemotherapy and axillary node clearance). In contrast we assessed a permissive policy in Newham, an inner London setting with high levels of socioeconomic deprivation and multiethnicity.MethodRetrospective review of patients receiving immediate breast reconstruction between 2014 and 2015 via assessment of electronic and paper patient notes. Risk factors and outcomes (implant loss) were measured at 3, 12 and 24 months. Results: Nineteen patients were identified as having unilateral immediate implant based reconstruction. Median age 50 ( Range 22-83), median BMI 28.8 (Range 18.7-46) Five (26%) were smokers. Only 2 had a single comorbidity( 10.5%). Seventeen (89.5%) had more than one comorbidity.Thirteen (67%) had an axillary node clearance, four ( 21%) received neoadjuvant chemotherapy (NACT) and 12 (63%) received adjuvant chemotherapy. Ten patients (52%) received adjuvant radiotherapy (RT).One had implant loss at 3 months ( 5%) The number of implant failures at 1 year was 4 (21%) and at 2 years was 5 (26%).ConclusionImplant loss at 3 months is at an acceptable limit but loss at 1 year is high. However, this is in a cohort of patients in whom many units would have denied them any immediate reconstruction. Hence the ethical dilemma. At what cost is a unit's figures against those of the individual patient?
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