Breast Reconstruction:Upon Diagnosis…

Michael J Bass, MD, JDwww.drmichaeljbass.com

859-543-1024

Disclosures

• None• I need some

Support Provided By

• Lifecell– AlloDerm– Strattice

Lecture Layout

• Dr. Michael Bass – state of breast cancer in the U.S., preoperative analysis, timing of care

• Dr. Monica Hall – implant-based versus autologous breast reconstruction

• Dr. Theresa LeVan – autologous fat grafting breast reconstruction

• Dr. Michael Bass – satisfaction surveys and outcomes analysis

Part 1 Layout

• Incidence of breast cancer• Trends in breast cancer• Risk by age• Preoperative assessment• Preoperative considerations

Incidence of Breast Cancer

• CDC 2008: 210,203 breast cancer diagnoses– 40,589 deaths

• White > Black > Hispanic > Asian > American Indian

• Kentucky: 117-121:100,000, third quartile among states

Diagnosis Trends in U.S.: 1999-2008

• Decreased by 1.2% per year among white women.

• Remained level among black, Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander women.

http://www.cdc.gov/cancer/breast/statistics/trends.htm

Mortality Trend in U.S.: 1999-2008

• Decreased by 2.0% per year among women overall by:– 2.1% per year among white women– 1.4% per year among black women– 1.5% per year among Hispanic women

• Remained level among American Indian/Alaska Native women and Asian/Pacific Islander women.

Risk by age

Expected Survival Before Diagnosis10 Years 20 Years 30 Years

Current Age30 0.43 1.86 4.1340 1.45 3.75 6.8750 2.38 5.60 8.6660 3.45 6.71 8.65

Preoperative Analysis

• Color – skin and nipple areolar complex (NAC)

• Breast shape• Ptosis of NAC and

breast tissue• Volume

Preoperative Analysis

• Patient measurements– BMI– Height– Weight– Suprasternal notch to

nipple, clavicle to nipple, nipple to inframammary fold, breast base diameter

Preoperative Analysis

Preoperative Considerations

• Type of breast cancer– DCIS, Invasive Ductal, Lobular, Medullary, Tubular,

Mucinous (Colloid)• Neoadjuvant chemotherapy• Radiation• What treatments have been started

When To See A Plastic Surgeon

• Immediately after the diagnosis is made• Patients gain comfort in reconstructive

counseling• Photos, biometric analysis, and coordinating

care with other physicians from the very beginning

• Women’s Health and Cancer Rights Act of 1998 (29 U.S.C. 1185)