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Rates and trends in secondary breast procedures after the surgical treatment of breast cancer
Spencer R. Anderson MD; Major Nickolay P. Markov MD; R. Michael Johnson MD MPH; Major Justin P. Fox MD MHS.
Wright State University, Boonshoft School of Medicine
2019-02-14
Presenter: Spencer R. Anderson MD
Affidavit:
I certify this material is original, has not been presented nor published elsewhere, and the resident named on this paper has contributed to its production.
Director Name: R. Michael Johnson, MD MPH
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: The surgical treatment of breast cancer and subsequent reconstruction is often presented as a 1- or 2-stage procedure. However, the need for secondary procedures is common. We conducted this study to quantify rates of secondary procedures within 5 years of initial breast cancer surgery.
Methods: Utilizing Florida, Nebraska, and New York state inpatient and ambulatory surgery databases, we identified female breast cancer patients who underwent surgical treatment from January 1, 2007 to December 31, 2009. Patients were grouped by initial breast cancer surgery: lumpectomy, mastectomy, or mastectomy with expander, tissue, or direct-to-implant reconstruction. The primary outcome was the rate of secondary breast procedures per 1,000 patients within 5 years of initial surgery. Rates and trends were assessed using Poisson regression models.
Results: The final sample included 63,629 patients who underwent lumpectomy (50.1%), mastectomy (32.1%), or mastectomy with reconstruction (17.8%). Secondary procedures within 5 years of lumpectomy (269.5/1,000 patients), mastectomy (285.2/1,000 patients), and mastectomy with reconstruction (1,274.7/1,000 patients) were common with all rates increasing over time (p <0.001). Among the reconstructive cohorts, rates of secondary procedures were high for expander (1,448/1,000 patients), tissue (810/1,000 patients), and direct-to-implant (1,109/1,000 patients) groups with rates increasing by 37% (p <0.001), 23% (p 0.003), and 80% (p <0.001), respectively.
Conclusion: Despite efforts to surgically treat breast cancer in a limited number of encounters, current trends are leaning toward more numerous procedures. Future efforts should focus on safely maximizing progress at each step of treatment and reconstruction to minimize the need for secondary procedures.
