Breast reconstruction

Breast Reconstruction Affects Coping Mechanisms in Breast Cancer Survivors (2019)

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Type of publication:
Journal article

Author(s):
*Lake, Blossom; Fuller, Heidi R; *Rastall, Sarah; *Usman, Tamoor

Citation:
Indian Journal of Surgery; Feb 2019; vol. 81 (no. 1); p. 43-50

Abstract:
Coping strategies used by women with breast cancer are vital for adjustment to their disease. Whilst it is clear that factors such as age at diagnosis, social support and ethnicity can influence coping mechanisms, there is currently no information about whether breast reconstruction changes mechanisms of coping for such patients. The aims of this study, therefore, were to determine how women who have had immediate breast reconstruction and mastectomy cope, compared to those who have mastectomy alone, and whether there are differences in coping mechanisms due to breast reconstruction surgery. This was a retrospective cohort study, using a standardised questionnaire called the Brief Cope Scale. Inclusion criteria was the following: all women
who had immediate breast reconstruction and mastectomy in Shropshire from 2003 to 2014 for ductal carcinoma in situ or node-negative invasive breast cancer. Each patient was matched for year of diagnosis, adjuvant therapy and age to one woman who had mastectomy alone. Two hundred thirty-four questionnaires were sent with a 58% response rate. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.66, P value 0.04) compared to those in the mastectomy alone cohort. In contrast, significantly more patients in the mastectomy alone cohort coped by active venting compared to the reconstruction cohort (T value 1.71, P value 0.04). This study indicates for the first time that breast reconstruction may alter coping mechanisms in breast cancer survivors. Awareness of these coping mechanisms will enable clinicians to provide appropriate, individualised support.

Revision surgery following extended latissimus dorsi flap and implant based breast reconstruction: a district general hospital experience (2018)

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Type of publication:
Conference abstract

Author(s):
Dube M.; *Sheikh H.; *Rastall S.

Citation:
European Journal of Surgical Oncology; Jun 2018; vol. 44 (no. 6); p. 902-903

Abstract:
Introduction: Extended latissimus dorsi (ELD) flap breast reconstruction has been a very well-established reconstruction modality after mastec-tomy. Although recently number of ELD flap operation has decreased due to popularity of implant based reconstruction we found rate of revisional surgery were less with ELD reconstruction. Rates of revisional surgery have been quoted between 30%-75% in the literature. After 5 years we evaluate our rates of revision surgery. Methods: Analysis of a prospectively maintained breast reconstruction database. Types of initial surgery, complications and rate of revision sur-gery after radiotherapy specifically noted. Results: Total Reconstructions: 127 Immediate Reconstructions: 90 (78 ELD flap, 12 Implant only with acellular dermal matrix (ADM) Total patients who had further surgery 5 Fat grafting after ELD Flap 3 Fat grafting after implant only 1 Changeofimplant 1 *Patients with ELD reconstruction also had post-operative radiotherapy and 1 had small skin breakdown of the breast after primary surgery. Delayed Reconstructions: 37 Fat grafting after ELDflap Reconstruction 1 Symmetrisation surgery: 9 Total Patients requiring contralateral symmetry surgery 9 Augmentation mastopexy after immediate ELD 2 Mastopexy after delayed ELD 1 Reduction mastopexy after immediate ELD 4 Reduction mastopexy after delayed ELD 2 Time from primary surgery to symmetrisation or corrective surgery was between 8 months to 3 years. Conclusions: About 1.5% of patients required corrective surgery to the reconstructed or contralateral breast. High level of patient satisfaction found with ELD flap breast reconstruction than implant as only small number of patient required corrective surgery even after postoperative radiotherapy.

Breast reconstruction changes coping mechanisms in breast cancer survivorship (2016)

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Type of publication:
Conference abstract

Author(s):
*Lake B., *Fuller H.R., *Rastall S., *Usman T.

Citation:
Cancer Research, February 2016, vol./is. 76/4 SUPPL. 1(no pagination)

Abstract:
Introduction
Cancer survivorship is the process of living through and beyond cancer; a key part is how a patient copes with their diagnosis. Breast cancer is the most common malignancy of women worldwide and is known to be a severe stressor. Research has determined that the coping strategies used by women with breast cancer are vital to adjustment to their disease. Immediate breast reconstruction at the time of mastectomy with preservation of the breast form has been shown to be a positive influence on breast cancer patients however there are currently no studies to show whether breast reconstruction changes mechanisms of coping for such patients. The aim of this study, therefore, was to conduct a prospective cohort study to determine whether immediate breast reconstruction following mastectomy changes the way women with breast cancer cope with their diagnosis, compared to those who have mastectomy alone.
Method
A standardised questionnaire, the Brief Cope Scale was sent to two cohorts of patients who had a mastectomy and immediate reconstruction or mastectomy alone over an 11 year period 2003 to 2014 in Shropshire, England. It is a 28-point item with a four point Likert scale, which measures 14 different coping mechanisms: self-distraction, active coping, denial, substance use, use of emotional support, use of instrumental support, behavioral disengagement, venting, positive reframing, planning humour, acceptance, religion and self-blame. The inclusion criteria for this study was all woman who had mastectomy with immediate breast reconstruction in Shropshire between 2003 and 2014 for either Ductal carcinoma in situ (DCIS) or breast cancer which was node negative (cohort 1). The principle exclusion criteria were: men, node positive cancer, prophylactic mastectomy and breast reconstruction. Each index patient was matched for year of diagnosis, adjuvant therapy and age to woman who had mastectomy alone for DCIS or breast cancer which was node negative (cohort 2). An anonymous questionnaire was sent out to all patients identified who were still living, with a reminder letter at six weeks.
Results
Questionnaires were sent to a total of 234 patients; 117 patients in each cohort. Preliminary results indicate a response rate of 46%, with 60 responses from reconstruction cohort and 48 from mastectomy. The mean age was 50, with range 29 to 70 for reconstruction cohort, and the mean age of mastectomy cohort was 52, with range 32 to 70. Common coping styles for the reconstruction cohort were acceptance, active coping and use of emotional support. Common coping styles for mastectomy cohort were acceptance, use of emotional support and positive reframing. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.88 at P value 0.02). Significantly less patients coped by active venting in reconstructive cohort compared to mastectomy cohort; (T value 1.91 at P value 0.03).
Conclusion
Breast reconstruction alters coping mechanisms in breast cancer patients allowing less venting coping style and more active coping. Understanding how breast surgery changes coping mechanisms allows clinicians to understand cancer survivorship in breast cancer patients and helps to provide needed support.

Breast reconstruction changes: coping mechanisms in breast cancer survivors (2015)

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Type of publication:
Oral presentation

Author(s):
*Blossom Lake, *Heidi Fuller, *Sarah Rastall, *Tamoor Usman

Citation:
San Antonio Breast Cancer Symposium, December 2015

Abstract:
Background: Breast cancer is the commonest malignancy in women. Survivorship care for breast cancer patients needs to be individualised. A key component is recognition that coping mechanisms can be changed by treatment. The aims of this study were to see how women who have had immediate breast reconstruction and mastectomy, compared to those who have mastectomy alone cope and if there were significant differences in coping styles.

Methods: A cohort study using a standardised questionnaire the Brief Cope Scale. Inclusion criteria: all women who had had immediate breast reconstruction and mastectomy in Shropshire from 2003 to 2014 for node negative ductal carcinoma in situ or invasive breast cancer. Each index patient was matched for year of diagnosis, adjuvant therapy and age to one woman who had mastectomy alone.

Results: Questionnaires were sent to 234 patients, with a 58% response rate. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.66, P value 0.04). Significantly less patients coped by active venting in the reconstruction cohort (T value 1.71, P value 0.04).

Conclusion: Breast reconstruction changes coping styles of breast cancer patients, understanding this allows clinicians to individualise survivorship care.