Study Findings Could Help Women Make Decisions about Breast Cancer Surgery

By Jim Stallard,

Thursday, December 8, 2016

Surgeon in scrubs operating on patient.
Summary

Women undergoing mastectomy for breast cancer have two main options for reconstructive surgery: artificial implants or flap surgery using their own tissue. A new study looked at these options in women who received radiation after mastectomy and found that those whose surgery was done using their own tissue had significantly higher levels of satisfaction and lower risk of complications than women who received implants.

Highlights
  • Breast cancer often requires mastectomy as treatment.
  • These patients often choose reconstructive surgery.
  • The main options use implants or the patient’s own tissue.
  • Those using their own tissue have better outcomes.
  • This is especially true when radiation is given.

Cancer care is full of difficult choices. Women who undergo a mastectomy as part of treatment for breast cancer face a potentially life-changing decision: whether to have reconstructive surgery to rebuild the breast — and if so, what kind. The main options are either to use artificial implants filled with silicone or saline or to use the patient’s own tissue transferred from elsewhere in the body, such as the abdomen, generally known as flap surgery.

This decision becomes even more challenging for women who receive radiation following mastectomy to reduce the risk of cancer returning to the area. Radiation increases the risk of complications from surgery, such as infection, and can lead to changes in skin color and tissue shrinkage — leaving more women unhappy with their long-term quality of life.

It is crucial to be fully informed about the pros and cons of the different methods.
Andrea L. Pusic
Andrea L. Pusic Plastic and reconstructive surgeon

New findings presented today at the San Antonio Breast Cancer Symposium, a yearly gathering of thousands of oncologists and other cancer care professionals, add a critical piece of information that could help those facing this dilemma. Women receiving radiation after mastectomy reported significantly higher levels of satisfaction — and lower risk of complications — when they elected to have their breasts reconstructed using their own tissue.

“This is important information for women making a decision about reconstruction during a very stressful time,” says Memorial Sloan Kettering plastic and reconstructive surgeon Andrea Pusic, a study co-author. “It doesn’t mean they shouldn’t have implants — every decision should continue to be individualized and based on patient preference. But it is crucial to be fully informed about the pros and cons of the different methods, and this adds an essential piece of data.”

The results were reported by the Mastectomy Reconstruction Outcomes Consortium (MROC), a collaboration among 11 institutions to study patient attitudes toward various forms of breast reconstruction. Dr. Pusic leads the MROC along with Ed Wilkins, a reconstructive surgeon from the University of Michigan.

Radiation Widens Preference Gap

The study looked at complications and patient-reported outcomes two years after mastectomy among 553 women who received radiation and 1,461 who did not. Among those who received radiation, nearly 32% of those who got implants experienced at least one complication, compared with only about 24% of those who received their own tissue. In addition, in this same group a higher number of patients who received their own tissue reported being satisfied with the results (nearly 64%) compared with those who received an implant (about 48%).

Dr. Pusic says the findings align with what breast cancer surgeons already knew about reconstruction: that patients who receive their own tissue tend to be more satisfied than those who receive implants. But adding radiation to the mix appears to underscore this difference, making the gap even wider.

“Quantifying it in a study really makes a difference in clarifying how patients feel about the different types of reconstruction,” she explains. “Someone needing radiation often has worse disease, and they are less focused on the long term. This is very helpful in improving patients’ ability to make a good decision.”

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Importance of Patient Perspective

Dr. Pusic explains that the findings highlight the benefits of initiatives undertaken by the MROC and MSK’s own Patient-Reported Outcomes and Surgical Experience program, which is led by Dr. Pusic and seeks to enhance the quality of surgical care by taking a more patient-centric approach.   

“From the surgeon’s perspective, using implants or the patient’s own tissue were generally considered equal — the main difference being that flap surgery takes longer and leaves a scar where we take the tissue from,” she says. “The prevailing wisdom had been that if we thought a woman was going to need radiation, we would go with the implant, because we didn’t want to give radiation to the flap tissue. This new finding somewhat questions that prevailing wisdom because of how patients feel about the long-term outcomes.”

She emphasizes that reconstructive surgery choices still must be made within proven clinical guidelines. For example, a 75-year-old woman with heart problems would not be a good candidate for flap surgery, nor would someone who lacks adequate tissue for transfer.

“One method is not right for all women, but good information about expected outcomes is right for everyone,” she says.

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Comments

Where does Dr. Pusic see patients? Does she come to Commack?

Dear Marie, Dr. Pusic sees patients at MSK in Manhattan. However, you are welcome to consult with plastic surgeon Evan Matros, MD, who sees patients at MSK Commack. Here is his bio for your information: https://www.mskcc.org/cancer-care/doctors/evan-matros. To make an appointment with either surgeon, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

I had a mastectomy in 2004,w tram flap reconstruction then radiation.
Outcome was everything I hoped with no complications, a difficult decision to make but in looking at what i wanted as a result and being very well informed my decision was easier. (You never know how radiated tissue will react. Especially w implants). The most important thing is know all your options and think about the final result.

Unfortunately, there was no mention of male breast cancer. Treatment decisions and issues are difficult in the treatment of breast cancer, and must be weighed carefully. For a man with this terrible diagnosis, the research and statistics do not exist. For example, options for male breast reconstruction are not even mentioned.

Diane, thank you for your comment. We consulted with Dr. Pusic, who responds: "To my knowledge, men generally don't seek reconstruction."

I'm a premenopausal 44 yr old woman diagnosed with invasive ductal carcinoma and DCIS. I had a left total mastectomy with axillary dissection performed by Dr. Morrow and immediate DIEP reconstruction performed by Dr. Joseph Dayan in November 2017. The outcome was outstanding and I've been a registered nurse for over 20 years, never expereinced this level of compassion and empathy that I received with this amazing team of surgeons. This personal experience has restored my faith in the medical community once again! Thank you for being amazing!

Dear Kim, we're so glad to hear you had a good outcome from your surgery. We will forward your comments to Dr. Morrow and Dr. Dayan. Thank you for your comment, and best wishes to you.

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