Breast Cancer Jerome H. Liu, MD Tom S. Liu, MD Jerome H. Liu, MD Undergraduate: Brown University Medical School: University of California, Los Angeles Residency: UCLA Medical Center Fellowship:UCLA Medical Center Sub-Specialty Fellowship: University of Texas, Southwestern/Dallas Plastic Surgery Institute Practice Interests: Aesthetic (Cosmetic) Surgery, Breast, Free Flap Breast Microsurgery Tom S. Liu, MD Undergraduate: Northwestern University Medical School: University of Chicago, PritzkerSchool of Medicine Residency: UCLA Medical Center Fellowship: UCLA Medical Center Sub-Specialty Fellowship: California Pacific Medical Center Practice Interests: Aesthetic (Cosmetic) Surgery, Breast, Free Flap Breast Microsurgery Introduction to Breast Cancer and Treatment Lifetime Risk of Breast Cancer Currently, a woman living in the US has a 12.1%, or a 1 in 8, lifetime risk of being diagnosed with breast cancer. Teens 20s 30s 40s 50s 60s 70s 80s From 2003-2007, the median age at diagnosis for cancer of the breast was 61 yearsof age. Overview of Breast Cancer Treatments Generally a multi-step plan Localized treatments: Surgery Radiation therapy Systemic treatments: Chemotherapy Hormone therapy Biologic therapy Additional considerations: Breast reconstruction Contralateral breast surgery 1
Breast Overview Immediate vs. Delayed Breast Main goals of reconstruction: Restore breast mound Maintain/improve quality of life Process involves: Rebuilding the breast Autologous tissues Implants Reconstructing the nipple-areola complex Timing of reconstruction Immediate Delayed Immediate reconstruction is Usually preferred Regarded as the standard of care Not performed on all patients Benefits include: Preserves inframammary fold Maximizes available skin Psychological well-being Delayed reconstruction is an option for patients who: Need post-operative radiation Are undecided Types of Breast Procedures Breast Procedure Trends 2010 Total Implant-based reconstruction Autologous reconstruction Total 93,083 Tissue expander and implant 64,391 Implant alone 9,804 Introduction to Breast TRAM Flap Latissimus Dorsi Flap DIEP Flap 7,009 6,571 5,308 0 20,000 40,000 60,000 80,000 100,000 Breast : Implant (Two-Stage) Implant-Based Breast Stage 1: Tissue Expander Stage 2: Final Implant Source:Allergan 2
Stage 1: Tissue Expander Autologous Breast Source:Allergan and Lifecell Abdominal Flap Anatomy Free TRAM Flap Transverse Rectus Abdominus Myocutaneous TRAM Source:Microsurgeon.org Source:Microsurgeon.org Deep Inferior Epigastric Perforator (DIEP) Free Flap Microsurgical Breast (Video) Source:Microsurgeon.org 3
Microsurgical Breast Microsurgical Breast Microsurgical Breast The Challenging Breast Patient The Challenging Breast Patient Complications or failures of implant reconstruction Infection Capsular contracture Asymmetry / Malposition Post-operative radiation Post-lumpectomy contour defects Delayed mastectomy reconstruction Smoker Patient s who want a natural reconstruction Onco-Plastic Breast Image Source:The University of Chicago Hospitals 4
Onco-Plastic Breast Surgery Breast Cancer Safety and Patient Awareness Safety of Breast Safety of Breast Research shows reconstruction is oncologically safe No effect has been found on: Detection of cancer recurrence Delivery of adjuvant therapies Implants have not been linked to cancer or other diseases Higher 5-year survival than mastectomy alone, possibly due to: Increased follow-up Psychosocial benefits Access barriers for patients: Lack of knowledge Healthcare disparities by race Limited financial resources Physicians biases Favored patients Young Sexually active More educated Larger tumors Lack of access to plastic surgeons Other patient priorities: Focus on cancer treatment Lack of Patient Awareness about Breast Options Multidisciplinary Breast Care Heme-Onc Surg-Onc Rad-Onc Plastic Surgery A study found that 2 of 3 women with breast cancer were not told about their breast reconstruction options before surgery Genetics Social Work 5
Special Thanks Thank You ( 谢谢 )! Jerome H. Liu, MD, MSHS Tom S. Liu, MD, MBA Aesthetic and Reconstructive Plastic Surgery ( 整形外科 ) San Jose-Los Gatos / Los Altos 408-418-0808 www.liuplasticsurgery.com 6