Abstract P5-16-12: Implementation and outcomes of a microsurgical breast reconstruction program at a public cancer center in Mexico
Authors: Vargas-Salas D , Figueroa-Padilla J , Soto-Perez-de-Celis E , Maciel-Miranda A , Santamaria E , Zacarías-Gutiérrez LM , Cabrera-Galeana P , Bargallo-Rocha E 
Published: May 2019

Abstract
Background: Breast cancer (BC) is the most common malignancy in Mexico, and although many Mexican women need breast reconstruction, this is not covered by most public insurance schemes. The National Cancer Institute of Mexico (INCan), located in southern Mexico City provides care to uninsured individuals with all types of malignancies, including BC. In 2012, INCan received a grant from the Mexican federal government in order to establish the “Post-Mastectomy Program” (PMP), aimed at providing free breast reconstruction to women after mastectomy. Here, we describe the implementation and outcomes of our microsurgical breast reconstruction program.
Methods: We retrospectively reviewed medical records of all patients undergoing microsurgical breast reconstruction after mastectomy at INCan between the establishment of the PMP in 01/2013 and until 12/2017. Sociodemographic, clinical and surgical characteristics were collected. We also recorded for the presence of complications directly related to the reconstructive procedures, including local complications (infections, necrosis, thrombosis etc.), flap loss, need for reoperation and hospitalization time. Data were analyzed using descriptive statistics such as means, medians and proportions.
Results: 161 microsurgical breast reconstructions were conducted at INCan between 01/2013 and 01/2017, ranging from 23 in 2013 to 41 in 2016. Median patient age was 45 years (y) (21-66), and 57% had &lt; high school education. 2.5% had diabetes, 9.9% hypertension, and 2.5% rheumatologic diseases. Median body mass index was 26.8 (18.2-39), 82.6% were non-smokers and 46.5% (n = 108) had previous abdominal scars. Regarding reasons for mastectomy, 67.7% were due to invasive BC, 11.8% to ductal carcinoma in situ, and 5.6% to BRCA mutations. Of the 109 invasive carcinomas, 21.8% were stage I, 57.3% stage II, and 20% stage III; 21.7% received neoadjuvant chemotherapy. 125 patients underwent immediate reconstruction, of which 89 used unilateral deep inferior epigastric perforator flaps (DIEP), 35 bilateral DIEPs, and 1 other technique. Mean preoperatory albumin was 4.2g/dL (SD 0.35), while mean preoperatory hemoglobin was 14.2g/dL (SD 1.2). 41.6% of the patients (n = 67) had at least one surgical complication, with the most common being delayed wound healing in 17% and fat necrosis in 14%. 26% of patients had to be reoperated, and flap loss occurred in 13% (n = 21). No differences were noted in the clinical or surgical characteristics of patients with or without flap loss. Median length of stay was 6 days (range 2-17).
Conclusions:This is the first detailed description of the outcomes of a microsurgical reconstruction program in a country with limited resources. Developing and implementing such a program is feasible, and may provide access to breast reconstruction to women who would normally be unable to obtain it.
Citation Format: Vargas-Salas D, Figueroa-Padilla J, Soto-Perez-de-Celis E, Maciel-Miranda A, Santamaria E, Zacarías-Gutiérrez LM, Cabrera-Galeana P, Bargallo-Rocha E. Implementation and outcomes of a microsurgical breast reconstruction program at a public cancer center in Mexico [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-12.