Conclusion: As physicians involved at multiple levels in the treatment of breast cancer patients, it is our duty to understand the basics of diagnostic and treatment options for our patients, but also to promote specific counseling about the potential benefits of reconstruction within the medical and general communities. Raising awareness about breast reconstruction enables more women to consider it as an option that for many will translate into an improved quality of life as a breast cancer survivor

Lalikos, Janice F

Lujan-Hernandez, Jorge

Perez Martinez, Mauricio

Archives of Plastic Surgery

PubMed

Harvard University - DASH 

Breast Reconstruction: Closingthe Loop after Breast CancerThe Harvard community has made thisarticle openly available.  Please share  howthis access benefits you. Your story mattersCitation Lujan-Hernandez, Jorge, Mauricio Perez Martinez, and Janice FLalikos. 2015. “Breast Reconstruction: Closing the Loop after BreastCancer.” Archives of Plastic Surgery 42 (4): 511-512. doi:10.5999/aps.2015.42.4.511. http://dx.doi.org/10.5999/aps.2015.42.4.511.Published Version doi:10.5999/aps.2015.42.4.511Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:17820798Terms of Use This article was downloaded from Harvard University’s DASHrepository, and is made available under the terms and conditionsapplicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAAVol. 42 / No. 4 / July 2015511It is winter and I’m assigned to cover some shifts in the radiation oncology clinic on a research project. A few months ago, I got to meet her as a patient for the first time, and today after several visits, I see her for the last time. Across her chest, she carries two large battle scars. Her eyes reflect deep sorrow and tremendous fatigue, but at the same time a strong desire to live. Having endured months of chemo-therapy, radiation and surgery, she knows her personal crusade has finally come to an end. She has passed through the tough journey, at least for now. As her last radiotherapy session ends and she begins to walk away, she stops suddenly and turns back to face me. Looking into my eyes she says timidly: “Thank you. I’ve made it, I’m ready to move on”. Breast cancer continues to be the second deadliest malignancy in women. However, compared to past decades, studies have shown that the combination of modern post-mastectomy radiation therapy, chemotherapy with receptor antagonists and surgery, significantly improves survival and reduced loco-regional recurrence. These ef-forts have achieved a five year survival greater than 89% [1-3]. How-ever, while so many women can achieve a normal life after eradicating cancer, the breast cancer chronicle remains unconcluded for 7 out of 10 survivors because they are not whole [4]. Breast reconstruction continues to be neglected in many areas and considered an optional cosmetic procedure, leaving patients with a persistent reminder of their disease. Multiple clinical studies have demonstrated through validated as-sessment tools (BREAST-Q, RAND-36, General Health Question-naire GHQ) that breast reconstruction really matters, significantly improving psychological well being, self-image, sexuality, as well as overall functionality and strength to overcome disease. The benefits are not exclusive for the younger population, Sisco et al. [5] corrobo-rated that improvement on the quality of life does not diminish with age. Despite this recent knowledge, only around 30% of patients un-dergoing mastectomy are made aware of the options for restoration, and these rates are even lower in underserved areas and in minority populations [4].  In the last decade, rates of breast reconstruction have been increas-ing at only a modest pace [6]. A recent Australian study [7] proves that by offering every mastectomy patient the option of reconstruc-tion during a multidisciplinary visit, the likelyhood of breast recon-struction increased from the national average of 12% to 41%. While many factors influence each patient’s individual decision to proceed or not to proceed with reconstruction, only through raising aware-ness we will be able to provide truly comprehensive care to every patient. Furthermore, campaigns such as as the Breast Cancer Awareness Month, (October of every year, http://www.bradayusa.org) started in 2012 and propelled by the American Society of Plastic Surgeons (ASPS) and The Plastic Surgery Foundation (PSF), the effort to “educate, engage and empower women to make the decision that is best for them following a diagnosis with breast cancer” has acquired a strong presence in the care of cancer patients. These types of campaigns inform patients on the next step after such a traumatic and life-changing process. Raising awareness also helps support research to improve the available options. Worldwide, professionals from either the research labs or the operating rooms, strive every day to discover novel options for reconstruction—exploring autologous or synthetic based techniques—aiming to be less invasive, safer and more successful. It is important that this effort does not stop after October.  As physicians involved at multiple levels in the treatment of breast cancer patients, it is our duty to understand the basics of diagnostic and treatment options for our patients, but also to promote specific counseling about the potential benefits of reconstruction within the medical and general communities. Raising awareness about breast reconstruction enables more women to consider it as an option that for many will translate into an improved quality of life as a breast cancer survivor.  References  1. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. COMMUNICATIONBreast Reconstruction: Closing the Loop after Breast CancerJorge Lujan-Hernandez1, Mauricio Perez Martinez2, Janice F Lalikos11Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, MA; 2Division of Thoracic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USACorrespondence: Jorge Lujan-HernandezDivision of Plastic Surgery, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01655, USATel: +1-857-205-7877, Fax: +1-508-856-5250E-mail: Jorge.Lujan-Hernandez@umassmed.eduNo potential conflict of interest relevant to this article was reported.Received: 20 May 2015 • Revised: 20 May 2015 • Accepted: 20 May 2015 pISSN: 2234-6163 • eISSN: 2234-6171 http://dx.doi.org/10.5999/aps.2015.42.4.511 • Arch Plast Surg 2015;42:511-512Copyright  2015 The Korean Society of Plastic and Reconstructive SurgeonsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Communication512Lancet 2005;366:2087-106.  2. Gieni M, Avram R, Dickson L, et al. Local breast cancer recurrence after mastectomy and immediate breast reconstruction for invasive cancer: a meta-analysis. Breast 2012;21:230-6.  3. Somogyi RB, Webb A, Baghdikian N, et al. Understanding the factors that influence breast reconstruction decision making in Australian women. Breast 2015;24:124-30.  4.  American Society of Plastic Surgeons. ASPS launches campaign to educate women about their options [Internet]. Arlington Heights, IL: American Society of Plastic Surgeons; 2012 [cited 2014 Oct 1]. Available from: http://www.plasticsurgery.org/news/past-press-releases/2012-archives/new-survey-women-want-to-see-breast-reconstruction-results-before-cancer-surgery.html.  5. Sisco M, Johnson DB, Wang C, et al. The quality-of-life benefits of breast reconstruction do not diminish with age. J Surg Oncol 2015;111:663-8.  6. Kruper L, Xu X, Henderson K, et al. Disparities in reconstruction rates after mastectomy for ductal carcinoma in situ (DCIS): patterns of care and factors associated with the use of breast reconstruction for DCIS compared with invasive cancer. Ann Surg Oncol 2011;18:3210-9.  7. Wong A, Snook K, Brennan M, et al. Increasing breast reconstruction rates by offering more women a choice. ANZ J Surg 2014;84:31-6.

Breast Reconstruction: Closing the Loop after Breast Cancer

Jorge Lujan-Hernandez

Mauricio Perez Martinez

Janice F Lalikos

Directory of Open Access Journals

Lujan-Hernandez, Jorge R.

Lalikos, Janice F.

eScholarship@UMMS

University of Massachusetts Medical School eScholarship@UMMS Open Access Articles Open Access Publications by UMMS Authors 2015-07-01 Breast Reconstruction: Closing the Loop after Breast Cancer Jorge R. Lujan-Hernandez University of Massachusetts Medical School Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/oapubs  Part of the Neoplasms Commons, Plastic Surgery Commons, Surgery Commons, and the Women's Health Commons Repository Citation Lujan-Hernandez JR, Perez Martinez M, Lalikos JF. (2015). Breast Reconstruction: Closing the Loop after Breast Cancer. Open Access Articles. https://doi.org/10.5999/aps.2015.42.4.511. Retrieved from https://escholarship.umassmed.edu/oapubs/2697 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Open Access Articles by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. Vol. 42 / No. 4 / July 2015511It is winter and I’m assigned to cover some shifts in the radiation oncology clinic on a research project. A few months ago, I got to meet her as a patient for the first time, and today after several visits, I see her for the last time. Across her chest, she carries two large battle scars. Her eyes reflect deep sorrow and tremendous fatigue, but at the same time a strong desire to live. Having endured months of chemo-therapy, radiation and surgery, she knows her personal crusade has finally come to an end. She has passed through the tough journey, at least for now. As her last radiotherapy session ends and she begins to walk away, she stops suddenly and turns back to face me. Looking into my eyes she says timidly: “Thank you. I’ve made it, I’m ready to move on”. Breast cancer continues to be the second deadliest malignancy in women. However, compared to past decades, studies have shown that the combination of modern post-mastectomy radiation therapy, chemotherapy with receptor antagonists and surgery, significantly improves survival and reduced loco-regional recurrence. These ef-forts have achieved a five year survival greater than 89% [1-3]. How-ever, while so many women can achieve a normal life after eradicating cancer, the breast cancer chronicle remains unconcluded for 7 out of 10 survivors because they are not whole [4]. Breast reconstruction continues to be neglected in many areas and considered an optional cosmetic procedure, leaving patients with a persistent reminder of their disease. Multiple clinical studies have demonstrated through validated as-sessment tools (BREAST-Q, RAND-36, General Health Question-naire GHQ) that breast reconstruction really matters, significantly improving psychological well being, self-image, sexuality, as well as overall functionality and strength to overcome disease. The benefits are not exclusive for the younger population, Sisco et al. [5] corrobo-rated that improvement on the quality of life does not diminish with age. Despite this recent knowledge, only around 30% of patients un-dergoing mastectomy are made aware of the options for restoration, and these rates are even lower in underserved areas and in minority populations [4].  In the last decade, rates of breast reconstruction have been increas-ing at only a modest pace [6]. A recent Australian study [7] proves that by offering every mastectomy patient the option of reconstruc-tion during a multidisciplinary visit, the likelyhood of breast recon-struction increased from the national average of 12% to 41%. While many factors influence each patient’s individual decision to proceed or not to proceed with reconstruction, only through raising aware-ness we will be able to provide truly comprehensive care to every patient. Furthermore, campaigns such as as the Breast Cancer Awareness Month, (October of every year, http://www.bradayusa.org) started in 2012 and propelled by the American Society of Plastic Surgeons (ASPS) and The Plastic Surgery Foundation (PSF), the effort to “educate, engage and empower women to make the decision that is best for them following a diagnosis with breast cancer” has acquired a strong presence in the care of cancer patients. These types of campaigns inform patients on the next step after such a traumatic and life-changing process. Raising awareness also helps support research to improve the available options. Worldwide, professionals from either the research labs or the operating rooms, strive every day to discover novel options for reconstruction—exploring autologous or synthetic based techniques—aiming to be less invasive, safer and more successful. It is important that this effort does not stop after October.  As physicians involved at multiple levels in the treatment of breast cancer patients, it is our duty to understand the basics of diagnostic and treatment options for our patients, but also to promote specific counseling about the potential benefits of reconstruction within the medical and general communities. Raising awareness about breast reconstruction enables more women to consider it as an option that for many will translate into an improved quality of life as a breast cancer survivor.  References  1. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. COMMUNICATIONBreast Reconstruction: Closing the Loop after Breast CancerJorge Lujan-Hernandez1, Mauricio Perez Martinez2, Janice F Lalikos11Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, MA; 2Division of Thoracic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USACorrespondence: Jorge Lujan-HernandezDivision of Plastic Surgery, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01655, USATel: +1-857-205-7877, Fax: +1-508-856-5250E-mail: Jorge.Lujan-Hernandez@umassmed.eduNo potential conflict of interest relevant to this article was reported.Received: 20 May 2015 • Revised: 20 May 2015 • Accepted: 20 May 2015 pISSN: 2234-6163 • eISSN: 2234-6171 http://dx.doi.org/10.5999/aps.2015.42.4.511 • Arch Plast Surg 2015;42:511-512Copyright  2015 The Korean Society of Plastic and Reconstructive SurgeonsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Communication512Lancet 2005;366:2087-106.  2. Gieni M, Avram R, Dickson L, et al. Local breast cancer recurrence after mastectomy and immediate breast reconstruction for invasive cancer: a meta-analysis. Breast 2012;21:230-6.  3. Somogyi RB, Webb A, Baghdikian N, et al. Understanding the factors that influence breast reconstruction decision making in Australian women. Breast 2015;24:124-30.  4.  American Society of Plastic Surgeons. ASPS launches campaign to educate women about their options [Internet]. Arlington Heights, IL: American Society of Plastic Surgeons; 2012 [cited 2014 Oct 1]. Available from: http://www.plasticsurgery.org/news/past-press-releases/2012-archives/new-survey-women-want-to-see-breast-reconstruction-results-before-cancer-surgery.html.  5. Sisco M, Johnson DB, Wang C, et al. The quality-of-life benefits of breast reconstruction do not diminish with age. J Surg Oncol 2015;111:663-8.  6. Kruper L, Xu X, Henderson K, et al. Disparities in reconstruction rates after mastectomy for ductal carcinoma in situ (DCIS): patterns of care and factors associated with the use of breast reconstruction for DCIS compared with invasive cancer. Ann Surg Oncol 2011;18:3210-9.  7. Wong A, Snook K, Brennan M, et al. Increasing breast reconstruction rates by offering more women a choice. ANZ J Surg 2014;84:31-6.

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Breast Reconstruction: Closing the Loop after Breast Cancer

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