Abstract P2-19-07: Current trends of breast reconstruction after mastectomy for breast cancer patients in China
Authors: Chen Y , Chen J , Chen J , Yang B , Li L , Huang X , Shao Z , Shen Z , Wu J 
Published: August 2014

Background: To ascertain the current trends of breast reconstruction (BR) for breast cancer patients in China, we conducted a retrospective study in Committee of Breast Cancer Society, Chinese Anti-Cancer Association.

Methods: We designed a questionnaire for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy (RT) or chemotherapy, complication, oncoplastic surgery, fat grafting, physician and patient satisfaction, etc. All data were collected until 2012. Questionnaires were sent to 52 members of Committee of Breast Cancer Society by e-mail. By Jun-2013, 30 questionnaires (response rate 57.7%) had been returned. Among all, 3 were excluded for not performing BR. Finally, 27 respondents were included.

Results: All but one of these 27 hospitals were Class Three Grade A hospitals in China. A total of 402 surgeons worked in the general surgery or oncological surgery department, among them, only 84 (20.9%) were able to perform BR. Surgeons from 10 hospitals would also choose to cooperate with the plastic department to finish the complicated reconstructive procedure. In 2012, 21026 mastectomies were performed; among them, 679 (3.2%) received immediate BR, 102 (0.5%) received delayed BR while 192 (0.9%) received delayed-immediate one. At the same time, 414 (2.0%) had their breast reconstructed by implant while 393 (1.9%) chose the autologous ones, the choices of reconstructive type were not recorded for other 166 (0.8%) cases. According to these 27 respondents, 88.9% predominantly performed prosthetic (1265 cases in all) or latissimus dorsi myocutaneous flap (LDMF) with or without an implant (1571 cases in all) BR from the time of their first BR operation to the end of 2012. During the same period, 327 pedicled transverse rectus abdominis myocutaneous (TRAM) BR were performed in 20 hospitals, while 169 free TRAM BR, which requiring technique of microsurgery, were carried out in 9 hospitals (68.6% were performed by a single surgeon from Nov-2006). The overall complication rate of BR was 12.4%. As RT had low to medium effect on increasing the operational difficulties and influencing the esthetic outcomes of BR, about 75% surgeons would choose delayed autologous BR in patients who had previous RT. Autologous flaps were also recommended for patients who need postoperative RT, but the timing still remained controversial. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients.

Conclusion: With the growing number of breast cancer patients who need to undergo mastectomy, more and more BR are needed to improve the quality of life for them, but the ratio is still low in China, partially because of the lack of qualified plastic surgeons. As free flap BR requiring microsurgical techniques seems still complicated for most surgeons, implant and LDMF BR are the most common choices for patients nowadays in China. In addition, the effect of radiotherapy will be an important consideration when deciding the type and timing of BR.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-07.