Abstract P4-13-17: Eclectic breast reconstruction: A tailored approach
Authors: Maciel-Miranda A , Gutiérrez-Zacarías LM , Bargalló-Rocha JE 
Published: February 2018

Abstract
Methods that are eclectic combine whatever seems the best or most useful things from many different areas or systems, rather than following a single system.
There are several publications that compare one single technique against another: expander versus flap, pedicled flap versus free flap, etc. At Instituto Nacional de Cancerologia (INCan) we are able to offer several techniques for breast reconstruction: tissue expander/implant, direct-to implant, TRAM flap, DIEP flap, Latissiumus Dorsi flap, and the use of dermal acellular matrix.
In an eclectic approach we propose to use any of this techniques, depending on patient characteristics, individual risk estimation and shared decision-making approach.
We performed 110 breast reconstructions applying this innovative approach
Patient demographic and clinical characteristics (n=110)CharacteristicsNumber of patientsAge (years) mean ± standard deviation (SD)43 (±9.7)20-40 years41 (37.3%)40-50 years40 (36.4%)&gt;50 years29 (26.4%)Smoking (n %) Yes7 (6.4%)No84 (76.4%)Pasive1 (.9%)Discontinued18 (16.4%)BMI mean ± standard deviation (SD)26.35 (±4.05)Normal weight45 (40.9%)Overweight40 (36.4%)Obesity25 (22.7%)Breast volume (cc) median (p25-p75)425 (350-500)Unilateral88(80%)Bilateral22(20%)Breast Cancer Stage n (%) In situ2 (1.8%)IA23 (20.9%)IB2 (1.8%)IIA28 (25.5%)IIB20 (18.2%)IIIA22 (20 %)IIIB4 (3.6%)IIIC4 (3.6%)IV1 (.9%)*Without breast cancer and BRCA mutation4 (3.6%)Radiotherapy n(%) None52 (47.3%)Prior to mastectomy4 (3.6%)After mastectomy54 (49.1%)
. We also implemented enhanced recovery after surgery protocols for same day surgery (in expander to implant exchange), and did quality of life and satisfaction evaluation with BREAST-Q questionnaries. Reconstruction surgeries are summarized in table 2.
Reconstruction characteristicsCharacteristicsNumber of patientsReconstruction n(%) Bilateral22 (20%)Unilateral88 (80%)Type of Reconstruction n(%) Expander-implant60 (54.5%)Direct to implant17 (15.5%)Becker implant3 (2.7%)DIEP flap15 (13.6%)Oncoplastic2 (1.8%)Lattisimus dorsi flap6 (5.5%)TRAM flap5 (4.5%)
Complications were: none in 55(50%), mastectomy flap necrosis 8(7.3%), infection 3 (2.7%), lost of reconstruction 4 (3.6%), capsular contracture 27 (24.5%).
BREAST-Q questionnaries showed 100% would recommend reconstructive surgery. 91.7% felt included in the decision process. Satisfaction with breast (preoperative vs postoperative) 66.21 vs 81.13, Satisfaction with outcome 85.06, Psychosocial well being 80.75 vs 88.35, Physical well-being 74.92 vs 68.73, Sexual well-being 66.66 vs 72.84, Satisfaction with information 86.86, Satisfaction with surgeon 98.73, Satisfaction with medical staff 96.2.
There are several options with advantages and disadvantages, treatment should be individualized based on risk estimation and shared decision making, then applying ERAS protocols, and evaluation with BREAST-Q questionnaries. Plastic surgeons should dominate several options, to fulfill patient expectatives, and high complexity options should be derived to high volume centers. Breast reconstruction technique should also be tailored to regional circumstances on economic and human resources, technical capacity; even factors like OR time, costs, infrastructure and health system.
Citation Format: Maciel-Miranda A, Gutiérrez-Zacarías LM, Bargalló-Rocha JE. Eclectic breast reconstruction: A tailored approach [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-17.