TY - JOUR
T1 - Breast reconstruction timing and modality in context
T2 - A cross-sectional study in Uppsala, Maastricht, and Rome
AU - Smeele, Hansje P.
AU - Bijkerk, Ennie
AU - van Rooij, Joep A.F.
AU - Mani, Maria R.
AU - Lindell Jonsson, Eva
AU - Salgarello, Marzia
AU - Barone Adesi, Liliana
AU - van Kuijk, Sander M.J.
AU - van der Hulst, René R.W.J.
AU - Tuinder, Stefania M.H.
N1 - Funding Information:
We thank Bjorn Jennekens and Anna Nilsson for their help with data collection. This work was supported by travel grants from Erasmus+, and from GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center.
Funding Information:
This work was supported by travel grants from Erasmus?+?, and from GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/12/29
Y1 - 2023/12/29
N2 - Background: With the development and refinement of techniques most mastectomy patients nowadays are candidates for breast reconstruction. No one surgical technique fits all, however. Treatment choices are driven by patient characteristics and preferences, alongside policy and operational factors. These, in turn, might be expected to differ on several levels of aggregation, for example, countries, regions, and hospitals. The aim of this study was to compare choices for breast reconstruction timing and modality in Uppsala (Sweden), Maastricht (the Netherlands), and Rome (Italy). Methods: In this cross-sectional study, patients presenting for first-time post-mastectomy breast reconstruction in three teaching hospitals were included. The primary study outcomes were breast reconstruction timing and modality. Covariables were body habitus (i.e., body mass index, waist circumference, and mastectomy weight), health-related quality of life assessed with the BREAST-Q Reconstruction module, patient preferences assessed with a self-constructed questionnaire, and shared decision making assessed with the CollaboRATE questionnaire. Statistical tests were used to compare data across study sites. Results: Sixty-six participants were included. The most common choices for breast reconstruction timing and modality were delayed DIEP flaps in Uppsala (53%), immediate DIEP flaps in Maastricht (44%), and immediate prepectoral implants in Rome (92%). Participants in Rome were much slenderer than participants in Uppsala and Maastricht (mean body mass index 21.6, 26.2, and 26.3 kg/m2, respectively; p < 0.05). Participants in Uppsala and Maastricht highly valued material used for the reconstruction; participants in Rome were significantly more concerned with complications, scars, and recovery duration associated with the reconstruction. Conclusions: This study shows large differences in choices for breast reconstruction timing and modality in Uppsala, Maastricht, and Rome. Possible reasons for the observed variation include differences in patient characteristics, patient preferences, reconstructive techniques available, and reimbursement. Level of evidence: Level IV, Therapeutic study.
AB - Background: With the development and refinement of techniques most mastectomy patients nowadays are candidates for breast reconstruction. No one surgical technique fits all, however. Treatment choices are driven by patient characteristics and preferences, alongside policy and operational factors. These, in turn, might be expected to differ on several levels of aggregation, for example, countries, regions, and hospitals. The aim of this study was to compare choices for breast reconstruction timing and modality in Uppsala (Sweden), Maastricht (the Netherlands), and Rome (Italy). Methods: In this cross-sectional study, patients presenting for first-time post-mastectomy breast reconstruction in three teaching hospitals were included. The primary study outcomes were breast reconstruction timing and modality. Covariables were body habitus (i.e., body mass index, waist circumference, and mastectomy weight), health-related quality of life assessed with the BREAST-Q Reconstruction module, patient preferences assessed with a self-constructed questionnaire, and shared decision making assessed with the CollaboRATE questionnaire. Statistical tests were used to compare data across study sites. Results: Sixty-six participants were included. The most common choices for breast reconstruction timing and modality were delayed DIEP flaps in Uppsala (53%), immediate DIEP flaps in Maastricht (44%), and immediate prepectoral implants in Rome (92%). Participants in Rome were much slenderer than participants in Uppsala and Maastricht (mean body mass index 21.6, 26.2, and 26.3 kg/m2, respectively; p < 0.05). Participants in Uppsala and Maastricht highly valued material used for the reconstruction; participants in Rome were significantly more concerned with complications, scars, and recovery duration associated with the reconstruction. Conclusions: This study shows large differences in choices for breast reconstruction timing and modality in Uppsala, Maastricht, and Rome. Possible reasons for the observed variation include differences in patient characteristics, patient preferences, reconstructive techniques available, and reimbursement. Level of evidence: Level IV, Therapeutic study.
KW - Breast reconstruction
KW - Decision making
KW - Mastectomy
KW - Patient selection
U2 - 10.1007/s00238-023-02146-1
DO - 10.1007/s00238-023-02146-1
M3 - Article
SN - 0930-343X
VL - 47
JO - European Journal of Plastic Surgery
JF - European Journal of Plastic Surgery
IS - 1
M1 - 2
ER -