Medical Comorbidities in Breast Reconstruction
I discuss medical comorbidities and how they relate to healing and outcomes in breast reconstruction with ASPS board certified plastic reconstructive surgeon, Dr. Daniel Liu from Cancer Treatment Centers of America in Chicago. I would like to begin by giving you a definition of what medical comorbidities are from the interview with Dr. Liu.
Definition of Medical Comorbidities
Medical comorbidities are usually chronic health problems, often pre-existing, a person might have before the diagnosis of breast cancer. Dr. Liu points out for patients who have breast cancer, coming into the diagnosis does not always mean a patient will be without any other health issues, or comorbidities. When patients come to their plastic surgeon seeking medical advice for breast reconstruction Dr. Liu points out what is necessary during the patient consult in the video. Here is what he tells us.
Review the patient’s medical history.
Evaluate certain habits such as smoking or alcohol use.
Record and look at any medications being taken.
These variables play a role in healing after surgery and the goal is to minimize potential healing complications as much as possible. These might include:
Infections
Wounds that might develop after surgery
Worst case scenario would be an implant needing to be removed or a flap that does not heal because of poor blood flow.
Dr. Liu points out there are some things they can control and others outside of a surgeon’s control. Let’s take a look at the items that can be controlled.
Smoking: Assistance programs are offered to patients to stop smoking prior to surgery and discontinued use of nicotine producing products. We know smoking can constrict blood vessels and can lead to poor healing.
Obesity or high BMI (body mass index): Weight loss assistance to help patients meet weight loss goals prior to surgery is offered. Plastic surgeons have different criterion for what BMI should be achieved before performing surgery. The key point is, obesity can affect healing.
Conditions not quite in the control of the patient and/or physician include:
Diabetes, a chronic health condition. This can lead to infection and poor healing. Medications can be prescribed with the help of a family physician or endocrinologist to improve a patient’s hemoglobin A1c, glycemic or sugar levels over time, prior to surgery.
Rare disorders like blood clotting or connective tissue diseases will also impact healing. Dr. Liu points out they are quite uncommon but are not necessarily contraindications to surgery, but it is imperative to know about them to appropriately counsel patients and recommend one procedure over another in some cases.
Having cancer often brings additional considerations. For example, being treated with neo-adjunctive chemotherapy can diminish or compromise a person’s immune system. A strong immune system is important to tissues healing optimally after surgery.
Advice from a Patient Advocate if You Have Medical Comorbidities
As a patient advocate, my sage advice listening to Dr. Liu in the video is to take this information with you to your own plastic surgery consult. Discussion of medical comorbidities in breast reconstruction is part of the shared decision-making conversation that can potentially optimize patient and surgical outcomes.
We are grateful for Dr. Liu’s time and expertise.