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Breast Reconstruction: Upon Diagnosis Michael J Bass, MD, JD www.drmichaeljbass.com 859-543-1024

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Disclosures None I need some

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Support Provided By Lifecell AlloDerm Strattice

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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

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Part 1 Layout Incidence of breast cancer Trends in breast cancer Risk by age Preoperative assessment Preoperative considerations

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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

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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/tre nds.htm

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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.

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Risk by age Expected Survival Before Diagnosis 10 Years20 Years30 Years Current Age 300.431.864.13 401.453.756.87 502.385.608.66 603.456.718.65

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Preoperative Analysis Color skin and nipple areolar complex (NAC) Breast shape Ptosis of NAC and breast tissue Volume

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Preoperative Analysis Patient measurements BMI Height Weight Suprasternal notch to nipple, clavicle to nipple, nipple to inframammary fold, breast base diameter

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Preoperative Analysis

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Preoperative Considerations Type of breast cancer DCIS, Invasive Ductal, Lobular, Medullary, Tubular, Mucinous (Colloid) Neoadjuvant chemotherapy Radiation What treatments have been started

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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 Womens Health and Cancer Rights Act of 1998 (29 U.S.C. 1185)