Transcript CME Presentaion PC11 Movassaghi

Kiya Movassaghi, MD, DMD
Assistant Clinical Professor, Plastic Surgery
OHSU
W O M E N ’ S H E A LT H C A R E S Y M P O S I U M
S E P T E M B E R 10 , 2 010
DISCLOSURE STATEMENT
Kiya Movassaghi, MD, DMD has disclosed that he has financial interest or other relationship with
the manufacturers of medical commercial products:
Angiotech
Medicis
Kiya Movassaghi, MD, DMD declares that discussion of any medical commercial product known to her as
unlabeled, or outside of FDA approved indications will be clearly revealed by her to the audience as such.
Kiya Movassaghi, MD, DMD, declares that discussion of any investigational medical commercial product
outside of FDA approved indications will be clearly revealed by her to the audience as such.
BREAST CANCER
~500-600 new cases per year- In Lane county
Nationally- ~70% breast conservation vs. 30% mastectomy
Nationally-~20-30% will undergo reconstruction-
BREAST RECONSTRUCTION AND
WOMEN’S HEALTH
Congress guaranteed universal coverage for breast reconstruction after cancer surgery in
1998.
… So, why such a low rate of breast
Reconstruction?
NATIONAL UTILIZATION OF IMMEDIATE
AND EARLY DELAYED BREAST
RECONSTRUCTION,
(ALDERMAN PRS 2003)
10,404 mastectomy treatments for breast cancer
On average, 15.4% breast reconstruction within 1 st 4 months
 Atlanta- highest rate @ 33.6%
 Hawaii- Lowest rate @ 7.6%
NATIONAL UTILIZATION OF IMMEDIATE
AND EARLY DELAYED BREAST
RECONSTRUCTION,
(ALDERMAN PRS 2003)
Race- W> H> A> B
Socioeconomic status
Geographic location
Age- less than 45> 45-55> 55
Clinical factors- stage of disease, XRT, surgical oncologist, plastic surgeon
DARTMOUTH HITCHCOCK
MEDICAL CENTER STUDY,
(COLLINS, E; PRS 2003)
Well integrated breast care program
Average rate of immediate reconstruction 49%
All females considering mastectomy offered consult with a plastic surgeon
Is ~50% the “ideal” rate of breast reconstruction since all women are offered the option?
BREAST RECONSTRUCTION AND
WOMEN’S HEALTH
Concerns about masking recurrence overrated. Br Ca
is mostly a systemic disease; local recurrence
mostly superficial and not hidden by
reconstruction.
 Delaying reconstruction is not supported
BREAST RECONSTRUCTION AND
WOMEN’S HEALTH
Well proven psychological benefits of
breast reconstruction for recovering
mastectomy patients
has
-Defining the “right”
rate of breast reconstruction
clear policy implications for
women’s health
“Before Breast Is Removed, a Discussion
on Options”
(AUGUST 18,2010)
“ Now a state law,… will require New York hospitals
and doctors to discuss the options for breast
reconstruction with their patients before performing
cancer surgery, to give them information about
insurance coverage and to refer them to another
hospital, if necessary, for the reconstructive
surgery”.
ADVANTAGES OF PREMASTECTOMY
CONSULT WITH PLASTIC SURGEON
Allows the surgeon to assess patient’s baseline
anatomy
Allows the patient to learn all her reconstructive
options
Allows the plastic surgeon to take part in the
oncological surgery planning and hence help
produce the best possible cosmetic outcome
It makes immediate reconstruction with all its
psychological and cosmetic benefits to become a
reality
Options for Mastectomy
Modified Radical
Mastectomy
Skin Sparing
Mastectomy
Nipple Sparing
Mastectomy
Options for Breast
Reconstruction
Immediate
Delay
ADVANTAGES OF IMMEDIATE
RECONSTRUCTION
Psychological
Economical / Efficient
Preservation of native breast skin envelope  Superior cosmetic outcome with less
morbidity
Options for Breast
Reconstruction
Implant
(Alloplastic)
Patient’s Own Tissue
(Autogenous)
Combination
Breast Implants
AUTOGENOUS RECONSTRUCTION
Pedicled TRAM flap
Free TRAM flap
DIEP Flap
Latissimus flap
Latissimus sparing flap
SGAP flap
IGAP flap
TRAM flap
Latissimus flap
George Town Protocol
for
Nipple-Sparing
Mastectomy
IN SUMMARY
All women should be offered a consult with a plastic surgeon prior to breast cancer
surgery
Nipple / Skin sparing mastectomy is the ideal mastectomy technique
Immediate reconstruction is the ideal reconstruction for most patients