Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board

BACKGROUND The treatment of breast cancer requires a multidisciplinary approach, and patients are often referred to a multidisciplinary cancer clinic. The purpose of the current study was to evaluate the impact of this approach on the surgical management of breast cancer. METHODS The medical records of 149 consecutive patients referred to a multidisciplinary breast cancer clinic over a 1-year period with a diagnosis of breast cancer were reviewed retrospectively for alterations in radiologic, pathologic, surgical, and medical interpretations and the effect that these alterations had on recommendations for surgical management. RESULTS A review of the imaging studies resulted in changes in interpretations in 67 of the 149 patients studied (45%). This resulted in a change in surgical management in 11% of patients. Review of the pathology resulted in changes in the interpretation for 43 of the 149 patients (29%). Thirteen patients (9%) had surgical management changes made solely as a result of pathologic reinterpretation. In 51 patients (34%), a change in surgical management was recommended after discussion with the surgeons, medical oncologists, and radiation oncologists that was not based on reinterpretation of the radiologic or pathologic findings. Overall, a second evaluation of patients referred to a multidisciplinary tumor board led to changes in the recommendations for surgical management in 77 of 149 of those patients studied (52%). CONCLUSIONS The changes in management stemmed from differences in mammographic interpretation, pathologic interpretation, and evaluation by medical and radiation oncologists and surgical breast specialists. Multidisciplinary review can provide patients with useful additional information when making difficult treatment decisions. Cancer 2006. © 2006 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55868/1/22266_ftp.pd

Predictors of patients’ choices for breast-conserving therapy or mastectomy: a prospective study

A study was undertaken to describe the treatment preferences and choices of patients with breast cancer, and to identify predictors of undergoing breast-conserving therapy (BCT) or mastectomy (MT). Consecutive patients with stage I/II breast cancer were eligible. Information about predictor variables, including socio-demographics, quality of life, patients' concerns, decision style, decisional conflict and perceived preference of the surgeon was collected at baseline, before decision making and surgery. Patients received standard information (n = 88) or a decision aid (n = 92) as a supplement to support decision making. A total of 180 patients participated in the study. In all, 72% decided to have BCT (n = 123); 28% chose MT (n = 49). Multivariate analysis showed that what patients perceived to be their surgeons' preference and the patients' concerns regarding breast loss and local tumour recurrence were the strongest predictors of treatment preference. Treatment preferences in itself were highly predictive of the treatment decision. The decision aid did riot influence treatment choice. The results of this study demonstrate that patients' concerns and their perceptions of the treatment preferences of the physicians are important factors in patients' decision making. Adequate information and communication are essential to base treatment decisions on realistic concerns, and the treatment preferences of patients, (C) 2004 Cancer Research U

Abstract P4-13-10: Autologous immediate and delayed breast reconstruction utilizing micro fat grafts with and without dermatocutaneous flaps: A novel minimally invasive approach for reconstruction of small and medium size breasts

Abstract Background:Immediate breast reconstruction following mastectomy is a key quality metric of a comprehensive breast cancer program. Reconstructive options include autologous (DIEP, TRAM, Latissimus) and implant/ADM reconstruction. DIEP, TRAM, and Latissimus flaps are invasive procedures that require prolonged operative times, extended recoveries, and have donor site morbidity (scars, weakness, hernia, etc). Implant/ADM reconstruction historically has not provided the same aesthetic satisfaction as autologous reconstruction, and also requires monitoring and ultimate replacement of the prosthetic device. Fat grafting has been found to be a safe and effective adjunct to standard breast reconstructive techniques. Fat graft only breast reconstruction has been reported, but in conjunction with external suction based tissue expansion. Dermatocutaneous flaps have been described for immediate breast reconstruction, but only in large breasted women (Goldilocks technique). We used micro fat grafts alone (no pre expansion) and in combination with dermatocutaneous flaps at mastectomy, to reconstruct small to medium sized breasts. We have applied the fat graft only technique to both immediate and delayed reconstructions. Purpose: To present a novel, minimally invasive approach to reconstruction of small and medium sized breasts utilizing immediate or delayed micro fat grafts with and without immediate dermatocutaneous flaps. We also present immediate single stage bilateral breast reconstruction utilizing fat grafts, dermatocutaneous flaps, and nipple reconstruction. The authors will review patient selection criteria, surgical technique and present before and after photos. Results: 12 non radiated breast cancer patients underwent immediate reconstruction of 21 breasts, utilizing fat grafting (1 breast) or dermatocutaneous flaps and fat grafting (20 breasts). An additional 5 patients underwent a total of 8 delayed fat graft only breast reconstructions. A total of 17 patients underwent reconstruction of 29 breasts. One patient underwent immediate reconstruction of one breast and delayed reconstruction of the other. Average age=54 years. Average BMI=27.4. All immediate breast reconstruction patients were discharged home next day. Patients underwent a mean=2 (range 1-5) fat graft sessions. Average fat injected per session was 153 ml (range 50-325). For immediate fat graft reconstructions, volume of fat grafted at the time of the mastectomy averaged 76 ml (range 55-100 ml). Total mean follow up from first procedure was 9 months, range 3-24 months. Conclusion: The authors present a simple, minimally invasive approach to immediate and delayed breast reconstruction of small to medium sized breasts. Our approach is novel in that it combines fat grafts with dermatocutaneous flaps for immediate reconstruction and utilizes serial fat grafts without pre expansion for complete delayed breast reconstruction. The technique has been successfully utilized to complete both immediate unilateral and bilateral breast reconstruction in a single stage in select patients and with serial fat grafts in others. This is the largest series to date using this approach. Citation Format: Goldman BE, Cheng ZHM, Capasse JS, Staradub VL. Autologous immediate and delayed breast reconstruction utilizing micro fat grafts with and without dermatocutaneous flaps: A novel minimally invasive approach for reconstruction of small and medium size breasts [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-10.</jats:p