BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD...

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BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of Surgery University of Toronto Toronto, Canada

Transcript of BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD...

Page 1: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

BREAST

RECONSTRUCTION AND

SURGICAL ADVOCACYMitchell Brown MD MEd FRCSC

Plastic and Reconstructive Surgeon

Associate Professor, Department of Surgery

University of Toronto

Toronto, Canada

Page 2: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Thank you

to ASPSN

No Disclosures

Page 3: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Advocacy is a political

process by an individual

or group which aims to

influence decisions

within political,

economic, and social

systems and institutions.

Health advocacy supports and

promotes patient's health care rights

as well as enhance community health

and policy initiatives that focus on the

availability, safety and quality of care.

Page 4: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Based on the seven roles that

all physicians need to have, to

be better doctors: Medical

Expert, Communicator,

Collaborator, Manager, Health

Advocate, Scholar, and

Professional.

The CanMEDS Framework 2011

Describe knowledge, skills

and abilities that specialist

physicians need for better

patient outcomes

Page 5: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

As Health Advocates, physicians

responsibly use their expertise and

influence to advance the health

and well-being of individual

patients, communities, and

populations.

Respond to individual patient

health needs

Respond to health needs of the

community

Identify population based

determinants of health

Promote health of individuals and

communities

Page 6: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 7: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 8: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Dr James Namnoum

Page 9: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 10: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Pink Ribbon Story Foundation

Page 11: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

1 in 9 women will be diagnosed with breast cancer

Over 20,000 mastectomies were performed in

Canada annually

Post mastectomy breast reconstruction can improve

quality of life, assist in the recovery from breast

cancer, improve self confidence, help women restore

their body image and self esteem

Breast reconstruction is an OPTION and is not for

everyone

Page 12: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Evolution of Reconstructionvolume

Page 13: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Delayed Unilateral SP TRAM

Page 14: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Free TRAM Flap

Page 15: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Lat Dorsi with Round Gel Implant

Page 16: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Two Stage Implant Reconstruction

Page 17: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Shaped Implant and Nipple

Reconstruction

Page 18: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Unilateral SSM, Single Stage

• 45 yo

• L Invasive CA

• Breast asymmetry with L

breast lower than R

Page 19: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Surgical Plan

• Limited ellipse incision

• Oblique lift

• 115-401

Page 20: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 21: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 22: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Bilateral NSM, Single Stage

• 34 yo

• BRCA1

• Bilat NSM

• PA and Lateral incision

• MF420

Page 23: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 24: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 25: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

BREAST

RECONSTRUCTION 101A crash course on Post Mastectomy Breast

Reconstruction

Page 26: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

GOALS

• Restore symmetry

• Ease of daily life

• Clothing styles

• No prosthesis

• Restore confidence

• Self image

• Sexuality

• Improve QOL

Rosalind Maingot 1935

Page 27: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Timing of Reconstruction

• Immediate

• At same time as

mastectomy

• Ready to make a

decision

• Early stage or

prophylactic

• Unlikely to need

adjuvant therapy

• Delayed

• Any time after

mastectomy

• All options available

• Can obtain excellent

results

Page 28: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Reconstruction Options

• Autologous

• Using your own tissue

• Abdomen

• TRAM flap

• DIEP flap

• Back

• Latissimus flap

• Buttock

• SGAP flap

• Alloplastic

• Using implants

• Two stage with use of a

tissue expander

• Single stage direct to

implant

Page 29: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 30: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 31: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Why an Increase in Implant

Reconstruction?

Better devices

Internal support matrices

Morbidity of autologous

reconstruction

Changing demographics

younger patients

earlier diagnosis

more prophylactic

more bilateral

Page 32: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 33: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 34: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

TRAM and DIEP

Page 35: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 36: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

1995

• TRAM Patient

• ICU 24 hrs

• Epidural

• Foley

• 3-5 day admission

• PCA pump

Page 37: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

PROCESSES OF CARE IN

AUTOGENOUS BREAST

RECONSTRUCTION WITH PEDICLED

TRAM FLAPS:EXPEDITING POSTOPERATIVE DISCHARGE IN AN

AMBULATORY SETTING

Kristen Davidge, MD MSc

Mitchell Brown, MD MEd FRCSC

John Semple, MD MSc FRCSC

Pam Morgan, MD FRCPC

Page 38: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Background

• Womens College

Hospital

• Transition from in

patient to ambulatory

facility

• Requirement to refine

the care of the TRAM

flap patient

Page 39: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Develop a protocol towards less than 24 hour stay

following autogenous breast reconstruction

Page 40: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Protocol

• Preadmission patient education

• Standardized peri operative protocol

• Multimodal analgesia

• Anti emetics

• Thromboprophylaxis

• Antibiotics

• Defined surgical protocol

• Post discharge phone follow up and information access

Page 41: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Mean discharge time = 38.7 ± 27.6 hours (range

18-189)

Discharge <24h = 36

(40%)

5/35

(14%)

7/19

(37%)

24/29 (83%)

*Polychoric corr =

0.76

Page 42: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Latissimus Flap

Page 43: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 44: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Lat Dorsi with Textured Round Gel

Page 45: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Implant Reconstruction

Page 46: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Options

Traditional Two Stage Direct to Implant

Page 47: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Patients and surgeons would

clearly prefer a single stage

approach to breast

reconstruction

BUT NOT

at the expense of inferior

outcomes or unnecessary

risks

Page 48: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Creates a Balance

Direct to

Implant

Planned Two

Stage

More difficult

Less predictable

Limited indications

One shot only

Size limitations

Fewer procedures

Fewer recoveries

More rapid return to

“life”

Get two chances

Less risk of skin or nipple

compromise

Broader indications

Delays final outcome

Expansion period

More surgery

More recovery

Page 49: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

SSM, Direct to Implant

• 37 yo, L Breast CA,

BRCA1

• B Cup, no ptosis

Page 50: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Surgical Plan

• SSM

• Direct to Implant

• MF295

• Alloderm

• 6x16

• thick

Page 51: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Alloderm

• Acellular Dermal

Matrix

• Skin substitute

• Human cadaver

• Porcine

• SSM

• NSM

Page 52: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 53: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Nipple Areola Reconstruction

• At final stage

• Variety of options

• Areola

• Tattoo

• Skin graft

• Nipple

• Local flap

• Graft

Page 54: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Nipple Share and Tattoo

feet head

Page 55: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Nipple Reconstruction – Areola Tattoo and

Nipple Graft

Page 56: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Labial Graft and Tattoo

Page 57: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

C-V Flap and Tattoo

Page 58: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

In terms of artistry, beauty is in the eye of the

beholder and there are many artists to choose from.

Artist’s work can be printed from the internet and

held up against the breast for comparison.

Copyright - Cosmetic

Transformations

3 Dimensional Tattoo

Page 59: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 60: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 61: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Nipple Sparing Mastectomy

• BRCA1

• SN-N 21R, 22L

• N-IMF 6.0 R, 7.0 L

• Bilat NSM

• IMF approach

• ADM

• Shaped gel implant

Page 62: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Bilat NSM, DTI, MF335, 3 Month

Page 63: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 64: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

In Canada, less than 15% of

women who undergo

mastectomy receive

reconstructive breast surgery

Barriers to Access

Lack of Awareness

Failure to Adequately Educate

Page 65: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 66: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 67: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 68: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 69: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 70: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Breast Reconstruction Awareness Day

BRA Day

Page 71: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Breast Reconstruction Awareness Day

• Began in Canada 2011

• International launch

2012

Page 72: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Breast Reconstruction Awareness Day

Third Wednesday of October – Wed Oct 21, 2015

Page 73: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

MISSION

Develop and advance an

internationally

recognized annual day

that promotes

awareness and access

to reconstructive breast

surgery

Page 74: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

VISION

Prior to undergoing breast

cancer therapy, all women

will be offered information

about the options for

reconstructive breast surgery

and be provided access to

breast reconstruction in a

safe and timely manner

Page 75: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Values

Reconstructive breast surgery has a positive effect

on quality of life for women requiring breast

reconstruction

All women who are candidates for breast

reconstruction should be made aware of the

options available to them

All women who are candidates for breast

reconstruction should be offered treatment in a

safe and timely manner

Page 76: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

EDUCATION

ACCESS

AWARENESS

Page 77: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Education and Awareness

• Patients and their families

• Plastic Surgeons

• Surgeons, Oncologists, Primary Care Physicians

• Allied Health Personnel

• Support Groups and Organizations

• Media

• Government and Health Policy

Page 78: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 79: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Within the past two years, the states of New

York and Ohio have made it law that ALL

WOMEN who are diagnosed with breast

cancer or undergo a mastectomy MUST be

offered information about their options for

breast reconstruction

More states to follow

Breast Cancer Patient Education Act

Federal Law 2013

Page 80: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Access

• Skilled reconstructive surgeons in all communities across

Canada

• Multidisciplinary teams to support the reconstructive

process

• Insure continued medical coverage for breast

reconstruction

• Resources to support the reconstructive need

• Operating facilities, flexibility for coordinated surgical care, budgets

for devices

Page 81: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Utilize BRA Day to

deliver

KEY MESSAGES

Page 82: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Key Messages

• Statistics• Incidence of breast cancer

• Incidence of mastectomy

• Incidence of breast reconstruction• Geographical differences

• Rural vs Urban

• Academic vs Community

• Changing demographics dictate greater need and understanding of reconstruction options• Younger, BRCA, Prophylactic

• Bilateral

Page 83: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Utilization

• Published rates of population based post mastectomy

breast reconstruction

• US - 12.5-16%

• Ontario - 7.9%

• Nova Scotia - 3.8%

• Recent trends show steady increase

• Shift from Delayed BR to Immediate BR

Page 84: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Barriers to Breast Reconstruction

• Patient awareness

• “Referral” awareness• Oncologists, surgeons, primary care physicians

• Reconstruction resources• Plastic surgeons (number and training)

• OR facilities

• Budgets for devices, ADM

• Ability to collaborate in complex health environment• Coordination of immediate BR

Page 85: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Key Messages

• Breast Reconstruction is Evolving

• Changing technology• Microsurgery

• ADM

• Perioperative management resulting in shorter stays and rapid recovery

• Implants and expanders

• Fat grafting, stem cells, tissue engineering

Page 86: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Bring LIFE through

BRANDING AND MARKETING

Page 87: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

BRA Day Logo

Utilizes concept of pink ribbon. Double meaning of inner

loop: 1. Infinity sign 2. Closing the loop on breast cancer

Page 88: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

BRA Day Poster

Page 89: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

BRA DAY

CANADA

FACEBOOK

PAGE

BRA Day Canada

Page 90: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

TWITTER

BRA DAY

CANADA

PAGE

16.5K Reached

with Twitter

@BRAwareness

Page 91: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

BRA DAY

CANADA

WEBSITE

1,568 online registrants

13,712 visits to website

1,785 Unique Views

on OCT 15, 2014

4,261 Page Views

on OCT 15, 2014

www.bra-day.com

Page 92: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of
Page 93: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

I attend

BRA Day

because…

“I was recently diagnosed

with the BRCA2 gene

mutation and am hoping

to increase my

knowledge of breast

reconstruction options

and to connect with

women who have been

through it and can show

me their results and

share their experiences.”

Page 94: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Willow’s Show and Tell Lounge

Page 95: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

I Volunteer

because…

It is my great pleasure to

be on this side of the

breast cancer chapter and

to reach back and help

other women who are at

the early stages of the

journey. My hope for

every woman there last

night is that they all find

themselves in a position,

one day, to reach back

and help another woman

find courage and

acceptance and

wholeness.

Shelley

Page 96: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

BRA Day

helped me

because…Tonight offered me

information in a concrete

way that helped me

understand the

reconstruction process from

beginning to end.

I found the most powerful

and inspirational part of the

night to be the lounge at the

end. To meet and see

people who have been in my

place and stand on the other

side to talk about their

stories. To know that I will

one day be in their shoes.

Tracy

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Exhibitors, Friends and Supporters

Page 99: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Bus Banner – Okanaga, BC

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Flash Mob – Kelowna, BC

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Page 103: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Partnership with Willow

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BRA Day Brochure

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Page 106: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

International Launch 2012

United States

• Extensive PR campaign

• Over 175 events

• Jewel

• Charity concert

• Song release “Flower”

Jewel

Page 107: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

ASPS

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Page 111: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Over 30 Countries

• Australia

• New Zealand

• Taiwan

• Finland

• Spain

• Belgium

• Ireland

• Italy

• England

• Israel

Brazil Argentina New Zealand

Mexico Sweden Cayman Islands BVI

England South Korea Germany

Poland Switzerland Bulgaria Greece

Turkey Kuwait

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Ireland Belgium

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BRA Day Italy

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Page 117: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Bari Bologna Cagliari Catania Foggia Genova

Imola La Spezia Milano Modena Napoli Padova

Palermo Pavia Piacenza Potenza Roma Sondrio

Udine Varese

Page 118: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

“BRAVE” Bracelet

Braccialetto Cruciani

Page 119: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Greece

Ατζέντα

Ηµέρα Ενηµέρωσης για την Αποκατάσταση Μαστού (Breast

Reconstruction Awareness Day- BRA Day)Τετάρτη, 22 Οκτώβριος 2014, 19:00 Εµφανίσεις : 131

Ο καρκίνος του µαστού είναι πρώτος σε

συχνότητα τύπος καρκίνου στις γυναίκες και η

δεύτερη συχνότερη αιτία θανάτου γυναικών µε

καρκίνο. Μία στις εννέα γυναίκες κινδυνεύει να

νοσήσει στη διάρκεια της ζωής της. Οι διάφορες

χειρουργικές θεραπείες του καρκίνου του µαστού

όπως ογκεκτοµή, τεταρτεκτοµή και µαστεκτοµή,

ενδέχεται να επηρεάσουν αρνητικά την

αυτοεικόνα και την ποιότητα ζωής της ασθενούς. Αναφορικά µε την αποκατάσταση µαστού, λιγότερο από το 20%

των γυναικών που κάνουν µαστεκτοµή υποβάλλεται σε αποκατάσταση κι ακόµη µικρότερο ποσοστό υποβάλλεται

σε άµεση αποκατάσταση. Μία βασική αιτία αυτών των χαµηλών ποσοστών είναι η έλλειψη σωστής και έγκαιρης

ενηµέρωσης. Η αποκατάσταση είναι εφικτή µέσα από διάφορες χειρουργικές επεµβάσεις πλαστικής χειρουργικής,

οι οποίες µπορούν να βελτιώσουν την ποιότητα ζωής της ασθενούς και να την βοηθήσουν τόσο στην ανάκτηση της

αυτοπεποίθησής της όσο και στη βελτίωση της ψυχολογίας της µετά από το ογκολογικό χειρουργείο.

Η αστική, µη κερδοσκοπική οργάνωση «Λωτός» έχει ως βασικό στόχο την ανάπτυξη και προώθηση ενηµέρωσης

και πρόσβασης στην αποκατάσταση µαστού. Αποτελείται από επιστηµόνες που δραστηριοποιούνται σε όλο το

φάσµα της θεραπείας του καρκίνου του µαστού.

Η οµάδα του «Λωτού» οργανώνει για πρώτη φορά στην Ελλάδα µια εκδήλωση στα πλαίσια του εορτασµού της

Ηµέρας Ενηµέρωσης για την Αποκατάσταση Μαστού (Breast Reconstruction Awareness Day- BRA Day). To BRA Day

θεσµοθετήθηκε στον Καναδά το 2011, και από τότε γιορτάζεται σε 30 χώρες σε όλο τον κόσµο.

Η εκδήλωση θα πραγµατοποιηθεί την Τετάρτη 22 Οκτωβρίου 2014 & ώρα 19.00 στην Αίγλη Ζαππείου και

είναι ανοιχτή στο κοινό. Στόχο έχει να ευαισθητοποιήσει και να ενηµερώσει για την αποκατάσταση ως µέρος της

συνολικής θεραπείας του καρκίνου του µαστού. Οι επεµβάσεις αποκατάστασης έχουν επανορθωτικό χαρακτήρα,

στοχεύουν στο καλύτερο δυνατό αισθητικό αποτέλεσµα και µπορούν να βελτιώσουν σηµαντικά την ποιότητα ζωής

των γυναικών που χρειάζονται αποκατάσταση και το επιθυµούν.

Γλυκερία Μάρτου MD, MSc, FRCS Πλαστική Χειρουργός, Fellow of EBOPRAS

Πρόεδρος της αστικής, µη κερδοσκοπικής οργάνωσης ΛΩΤΟΣ

Πρόσκληση στην ηµερίδα

Συνέδρια κ.λπ.

Εκδηλώσεις ανά Κατηγορία

Ηµερολόγιο Ατζέντας

Προβολή Ηµερολογίου

Τετ Οκτ 22, 2014 @19:00 -

Ηµέρα Ενηµέρωσης για την Αποκατάσταση

Μαστού (Breast Reconstruction Awareness Day-

BRA Day)

Σαβ Οκτ 25, 2014 @00:00 - 11:59µµ

1st Cyprus Breast Reconstruction Meeting

Τετ Νοε 12, 2014 @00:00 - 11:59µµ

29ο Πανελληνιο Συνέδριο Χειρουργικής και

Διεθνές Χειρουργικό Forum 2014

Παρ Νοε 21, 2014 @00:00 - 11:59µµ

1st Hellenic – Turkish Congress on Senology

Τρι Μαρ 17, 2015 @00:00 - 11:59µµ

23rd Stuttgart rhinoplasty course, 1st Stuttgart

nose reconstruction symposium and

Rhinoplasty Society Europe meeting

«< Οκτώβριος 2014 >»

Κ Δ Τ Τ Π Π Σ

28 29 30 1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

Είστε εδώ: Αρχική Ατζέντα

Επιστηµονικές Εργασίες

Εκπαίδευση

Συνέδρια

Όλες οι Κατηγορίες ...

αναζήτηση... ΑΝΑΖΉΤΗΣΗ

Χρήσιµοι Σύνδεσµοι Χορηγοί Χάρτης Ιστότοπου Βοήθεια

Ελληνική ΕταιρίαΠλαστικής Επανορθωτικής &Αισθητικής Χειρουργικής

Ε. Ε. Π. Ε. Α. Χ.

Αρχική Η Εταιρεία Μέλη Πλαστική Χειρουργική Νοσοκοµεία Ατζέντα Επικοινωνία Σύνδεση

Page 120: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

Israel

Page 121: BREAST RECONSTRUCTION AND SURGICAL …BREAST RECONSTRUCTION AND SURGICAL ADVOCACY Mitchell Brown MD MEd FRCSC Plastic and Reconstructive Surgeon Associate Professor, Department of

BRA Day October 21, 2015


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