Breast Reconstruction Or Prosthesis After Mastectomy
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Breast Reconstruction Surgery for Mastectomy in Hospital Inpatient and Ambulatory Settings, 2009–2014
HEALTHCARE COST AND Agency for Healthcare UTILIZATION PROJECT Research and Quality STATISTICAL BRIEF #228 October 2017 Highlights Breast Reconstruction Surgery for ■ From 2009 to 2014, in 22 Mastectomy in Hospital Inpatient and States, the population rate of Ambulatory Settings, 2009–2014 breast reconstruction for mastectomy increased by 62 Adela M. Miller, B.S., Claudia A. Steiner, M.D., M.P.H., percent, from 21.7 to 35.1 per Marguerite L. Barrett, M.S., Kathryn R. Fingar, Ph.D., M.P.H., 100,000 women aged 18 years and Anne Elixhauser, Ph.D. or older. ■ Increases occurred for all age Introduction groups, but disproportionately so for women aged 65 years After a mastectomy (surgical removal of the breast), a woman and older, those covered by faces a complex and emotional decision about whether to have Medicare, and those who were breast reconstruction or live without a breast or breasts. There uninsured. are usually three main considerations in the decision: medical, sexual, and physical. Medical considerations include concerns ■ In 2014, women who lived in that breast reconstruction surgery lengthens recovery time and rural areas had fewer increases the chance for infection and other postoperative reconstructions (29 per 100 complications. Sexual considerations involve the impact of the mastectomies) compared with mastectomy on future sexual encounters. Physical features urban-dwelling women (41 include how breasts may define femininity and sense of self.1 reconstructions per 100 mastectomies). Several previous studies have shown an increase in breast ■ Growth in breast reconstructive 2,3,4 reconstruction for mastectomy. One study used a 2007 surgery was primarily national surgical database, another study used 2008 claims-based attributable to the following data of women insured through large private employers, and a factors: third study used the Nationwide Inpatient Sample (NIS) for 2005– 2011,5,6,7 part of the Healthcare Cost and Utilization Project o Ambulatory surgeries (HCUP) increased more than 150 percent. -
Partial Foot Prosthesis Physical Rehabilitation Programme 0868/002 09/2006 200 MISSION
MANUFACTURING GUIDELINES PARTIAL FOOT PROSTHESIS Physical Rehabilitation Programme 0868/002 09/2006 200 MISSION The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. It directs and coordinates the international relief activities conducted by the Movement in situations of conflict. It also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the International Red Cross and Red Crescent Movement. Acknowledgements: Jean François Gallay Leo Gasser Pierre Gauthier Frank Joumier International Committee of the Red Cross Jacques Lepetit 19 Avenue de la Paix Bernard Matagne 1202 Geneva, Switzerland Joel Nininger T + 41 22 734 60 01 F + 41 22 733 20 57 Guy Nury Peter Poestma E-mail: [email protected] Hmayak Tarakhchyan www.icrc.org © ICRC, September 2006 and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres. All photographs: ICRC/PRP Table of contents Foreword 2 Introduction 4 1. Footprint of sound side 5 2. Casting and rectification 6 3. Soft socket fabrication 7 4. Forefoot build-up 11 5. First fitting of soft socket 13 6. Draping of polypropylene 15 7. Trim lines 17 8. Fitting 20 9. Straps 21 10. Finished partial foot prosthesis 22 List of manufacturing materials 23 Manufacturing Guidelines Partial Foot Prosthesis 1 Foreword The ICRC polypropylene technology Since its inception in 1979, the ICRC’s Physical Rehabilitation Programme has promoted the use of technology that is appropriate to the specific contexts in which the organization operates, i.e., countries affected by war and low-income or developing countries. -
Breast Cancer Screening HEDIS Tip Sheet
HEDIS® Tip Sheet Effectiveness of Care Measure Breast Cancer Screening Breast cancer is the most common type of cancer, and the second leading cause of cancer-related deaths among women in the United States. Approximately 237,000 cases of breast cancer are diagnosed in women, and about 41,000 women die each year of breast cancer.1 Mammography is an effective screening tool for early detection of breast cancer and reduction of breast cancer mortality. California Health & Wellness want to help your practice increase Healthcare Effectiveness Data and Information Set (HEDIS®) rates. This tip sheet outlines key details of the Breast Cancer Screening (BCS) measure, its codes and guidance for documentation. Measure Women ages 50–74 who had a mammogram to screen for breast cancer in the past two years.2 Exclusions: • Patients who meet the following – A unilateral mastectomy criteria anytime during the without a modifier and measurement year: a left mastectomy with – Medicare patients ages 66 and service dates 14 days or older enrolled in an institutional more apart. special needs plans (I-SNP) or – A unilateral mastectomy living long-term in an institution. without a modifier and a – Patients ages 66 and older with right mastectomy with service frailty and advanced illness. dates 14 days or more apart. – Patients in hospice. – Absence of the left breast and absence of the right breast on the • Patients with bilateral mastectomy. same or different dates of service. Any of the following meet the criteria – Both of the following (on the same for bilateral mastectomy: or different dates of service): – Bilateral mastectomy or history. -
Chapter 21 LOWER LIMB PROSTHETICS for SPORTS and RECREATION
Lower Limb Prosthetics for Sports and Recreation Chapter 21 LOWER LIMB PROSTHETICS FOR SPORTS AND RECREATION † JOHN R. FERGASON, CPO*; AND PETER D. HARSCH, CP INTRODUCTION WHEN TO PROVIDE A SPORTS-SPECIFIC PROSTHESIS GENERAL-USE UTILITY PROSTHESIS SKIN TOLERANCE TO HIGH ACTIVITY GENERAL ALIGNMENT CONSIDERATIONS FOR SPORTS GENERAL COMPONENT CHOICES FOR FORCE REDUCTION IN SPORTS TRANSTIBIAL RUNNING TRANSFEMORAL RUNNING CYCLING ROCK CLIMBING WATER SPORTS WINTER SPORTS GOLF HIKING INJURIES AND LONG-TERM EFFECTS OTHER CONSIDERATIONS SUMMARY *Chief Prosthetist, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, Texas 78234 †Chief Prosthetist, C5 Combat Care Center Prosthetics, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Building 3, San Diego, California 92134 581 Care of the Combat Amputee INTRODUCTION The value of sports and recreation continues to be a reported stress, pain, and depression, as well as a primary motivational factor for many service members general increase in the quality of life.8 Participation in with newly acquired lower limb amputations. Whether physical activity has shown a positive relationship with they were competitive prior to their amputations or improved body image for many amputees.9 For many not, they will become competitive to overcome their active duty service members, the desire to continue in current physical limitations. The background and de- the Armed Forces is correlated to their physical abil- mographics of an active duty service member differ ity to return to their previous military occupational from the demographics of the majority of new civilian specialty. Amputation of a lower limb does indeed amputations that occur each year. -
The (Narrative) Prosthesis Re-Fitted Finding New Support for Embodied and Imagined Differences in Contemporary Art
The (Narrative) Prosthesis Re-Fitted Finding New Support for Embodied and Imagined Differences in Contemporary Art Amanda Cachia Independent scholar and PhD candidate The (Narrative) Prosthesis Re-Fitted This article undertakes analyses of the contemporary American artists Robert Gober and Cindy Sherman to argue that they use the tropes of the obscene, abject, and traumatic—as discussed by Hal Foster—to make literal and metaphorical reference to David T. Mitchell and Sharon L. Snyder’s narrative prosthesis and its “truth,” while simultaneously leaving out the lived experience of disability. Consideration is given to the works of artists Carmen Papalia and Mike Parr, who use complex embodiment as a new methodology to signify empowerment and agency over what we might previously have considered the obscene, abject, or traumatic. They transform traditional understandings of the “prosthetic” within the specific rhetoric of disability. Introduction Why is it so de rigueur for contemporary artists to use disabled embodiment as a means to convey troubled emotional states, as a narrative and literal prosthesis? Narrative prosthesis is a term originally developed by David T. Mitchell and Sharon L. Snyder, where the disabled body is often inserted into literary, or in this case, visual narratives as a metaphorical opportunity. The disabled body or character is used as a type of crutch or supporting device that allows the narrative to take a turn or a new direction, but often the relationship between the story itself and the disabled body is one based on exploi- tation. “Through the corporeal metaphor,” Mitchell and Snyder articulate, “the disabled or otherwise different body may easily become a stand-in for more abstract notions of the human condition, as universal or nationally specific; thus the textual (disembodied) project depends upon—and takes advantage of—the materiality of the body” (50). -
Breast Reconstruction with Expanders and Implants
Evidence-Based Clinical Practice Guideline: Breast Reconstruction with Expanders and Implants INTRODUCTION Disclaimer Evidence-based guidelines are strategies for patient management, The American Cancer Society estimates that nearly 230,000 American developed to assist physicians in clinical decision making. This women were diagnosed with invasive breast cancer in 2011.1 Many of guideline was developed through a comprehensive review of the these individuals will require mastectomy and total reconstruction of scientific literature and consideration of relevant clinical experience, the breast. The diagnosis and subsequent process can create signifi- and describes a range of generally acceptable approaches to diagnosis, cant confusion and distress for the affected persons and their families management, or prevention of specific diseases or conditions. This and, consequently, surgical treatment and reconstructive procedures guideline attempts to define principles of practice that should are of utmost importance in the breast cancer care continuum. In generally meet the needs of most patients in most circumstances. 2011, the American Society of Plastic Surgeons® (ASPS) reported an increase in the rate of breast reconstructions, citing nearly 100,000 However, this guideline should not be construed as a rule, nor procedures, of which the majority employed expanders/implants.2 should it be deemed inclusive of all proper methods of care The 3% increase in reconstructions over the course of just one year or exclusive of other methods of care reasonably directed at highlights the significance of maintaining patient safety and obtaining the appropriate results. It is anticipated that it will be optimizing surgical outcomes. necessary to approach some patients’ needs in different ways. -
ASPS Clinical Practice Guideline Summary on Breast Reconstruction with Expanders and Implants
CME ASPS Clinical Practice Guideline Summary on Breast Reconstruction with Expanders and Implants Amy Alderman, M.D., M.P.H. Learning Objectives: After reading this article, participants should be able to: Karol Gutowski, M.D. 1. Understand the evidence regarding the timing of expander/implant breast re- Amy Ahuja, M.P.H. construction in the setting of radiation therapy. 2. Discuss the implications of a Diedra Gray, M.P.H. patient’s risk factors for possible outcomes and complications of expander/implant Postmastectomy breast reconstruction. 3. Implement proper prophylactic antibiotic protocols. 4. Use Expander/Implant Breast the guidelines to improve their own clinical outcomes and reduce complications. Reconstruction Guideline Summary: In March of 2013, the Executive Committee of the American Society Work Group of Plastic Surgeons approved an evidence-based guideline on breast reconstruc- Arlington Heights, Ill. tion with expanders and implants, as developed by a guideline-specific work group commissioned by the society’s Health Policy Committee. The guideline addresses ten clinical questions: patient education, immediate versus delayed reconstruction, risk factors, radiation therapy, chemotherapy, hormonal therapy, antibiotic prophylaxis, acellular dermal matrix, monitoring for cancer recur- rence, and oncologic outcomes associated with implant-based reconstruction. The evidence indicates that patients undergoing mastectomy should be offered a preoperative referral to a plastic surgeon. Evidence varies regarding the as- sociation between postoperative complications and timing of postmastectomy expander/implant breast reconstruction. Evidence is limited regarding the opti- mal timing of expand/implant reconstruction in the setting of radiation therapy but suggests that irradiation to the expander or implant is associated with an increased risk of postoperative complications. -
Procedure: Mastectomy Instructions Surgery Information: 1
Procedure: Mastectomy Instructions Surgery Information: 1. Please stop all vitamins, supplements, and herbal medications one week before surgery, your surgeon will review any other medications that need to be stopped before surgery 2. Surgery will take about 2.5 hours 3. Surgery will be at Aspirus Wausau Hospital 4. You will have General Anesthesia 5. You will likely go home 24 hours after your surgery, but may stay longer if needed 6. If you are sensitive to tape, please tell your check-in nurse on your day of surgery 7. You will need an appointment with us about 1 week after your surgery for an incision check unless you had reconstruction (then your post-operative appt. will be with your Plastic Surgeon) Follow up appt:__________________ 8. We will call you typically within 3 business days with final pathology results 9. Please remember to wear the binder the you were given at all times (unless showering) until two weeks after your last drain is removed– the binder can be washed and hung to dry if needed. If your binder is itchy you can try wearing a T-shirt/tank top underneath or use an ACE wrap for gentle compression. AVOID more than slight pressure. Restrictions: 1. No lifting more than 15lbs. for 2 weeks after the last drain is removed 2. You will be given arm exercises by occupational therapy before you leave the hospital. It is important that you follow the instructions you are given 3. No pushing, pulling, or stretching overhead for 2 weeks after the last drain is removed. -
The Effects of Prosthesis Use Versus Non-Use on Forward Reach
Grand Valley State University ScholarWorks@GVSU Masters Theses Graduate Research and Creative Practice 1999 The ffecE ts of Prosthesis Use Versus Non-use on Forward Reach Distance in Children Ages 5 to 15 with Unilateral Upper Extremity Amputation as Measured by the Functional Reach Test Mary E. Weber Grand Valley State University Follow this and additional works at: http://scholarworks.gvsu.edu/theses Part of the Physical Therapy Commons Recommended Citation Weber, Mary E., "The Effects of Prosthesis Use Versus Non-use on Forward Reach Distance in Children Ages 5 to 15 with Unilateral Upper Extremity Amputation as Measured by the Functional Reach Test" (1999). Masters Theses. 346. http://scholarworks.gvsu.edu/theses/346 This Thesis is brought to you for free and open access by the Graduate Research and Creative Practice at ScholarWorks@GVSU. It has been accepted for inclusion in Masters Theses by an authorized administrator of ScholarWorks@GVSU. For more information, please contact [email protected]. The Effects of Prosthesis Use Versus Non-use on Forward Reach Distance in Children Ages 5 to 15 with Unilateral Upper Extremity Amputation as Measured by the Functional Reach Test by Mary E. Weber Scot G. Smith THESIS Submitted to the Physical Therapy Program at Grand Valley State University Allendale, Michigan in partial MGHment o f the requirements for the degree of MASTER OF SCIENCE IN PHYSICAL THERAPY 1999 THESIS COMMITTEE APPROVAL: H U U u Chair; Mary/^. Green, M.S., P.T. .v ü fa i. Mi rn y i.LiitLMi : Je m ^ r McWain, M.S., P.T. The Effects of Prosthesis Use Versus Non-use on Forward Reach Distance in Children Ages 5 to 15 with Unilateral Upper Extremity Amputation as Measured by the Functional Reach Test ABSTRACT The purpose o f this study was to investigate the possible differences in maximal forward reaching distance in children with unilateral upper extremity amputations while wearing and not wearing a prosthesis using the Functional Reach (FR) test. -
Rehabilitation of People with Physical Disabilities in Developing Countries
Rehabilitation of people with physical disabilities in developing countries Program Report for Collaborative Agreement: DFD-A-00-08-00309-00 September 30, 2008 – December 31, 2015 Author: Sandra Sexton March 2016 ISPO Registered Office: International Society for Prosthetics and Orthotics (ISPO) c/o ICAS ApS Trekronervej 28 Strøby Ergede 4600 Køge Denmark Correspondence: International Society for Prosthetics and Orthotics 22-24 Rue du Luxembourg BE-1000 Brussels, Belgium Telephone: +32 2 213 13 79 Fax: +32 2 213 13 13 E-mail: [email protected] Website: www.ispoint.org ISBN 978-87-93486-00-3 1 Contents Page 1. Executive summary 3 2. List of acronyms 4 3. Acknowledgements 5 4. Introduction and background 6 4.1 Prosthetics and orthotics in developing countries 6 4.2 The prosthetics and orthotics workforce 6 5. Program activities, progress and results 7 5.1 Scholarships 7 5.2 Measuring the impact of training in prosthetics and orthotics 13 5.3 Enhancement of prosthetics and orthotics service provision 18 6. Budget and expenditure 22 7. References 23 2 1. Executive Summary Prosthetics and orthotics services enable people with physical impairments of their limbs or spine the opportunity to achieve greater independence to participate in society. Alarmingly, such services are not available to an estimated 9 out of 10 people with disabilities globally due to a shortage of personnel, service units and health rehabilitation infrastructures1. To try and address this situation, our International Society for Prosthetics and Orthotics (ISPO) members have been working towards development of the prosthetics and orthotics sector since our Society’s inception in the 1970s. -
Silicone-Filled Breast Implants
Important Information for Women About Breast Reconstruction with INAMED® Silicone-Filled Breast Implants RECON Patient Labeling Rev 11/03/06/06 page 1 TABLE OF CONTENTS Page GLOSSARY ..................................................................................................................................... 4 1. CONSIDERING SILICONE GEL-FILLED BREAST IMPLANT SURGERY ............................ 10 1.1 WHAT GIVES THE BREAST ITS SHAPE? ...................................................................... 11 1.2 WHAT IS A SILICONE GEL-FILLED BREAST IMPLANT? .............................................. 11 1.3 ARE SILICONE GEL-FILLED BREAST IMPLANTS RIGHT FOR YOU? ......................... 12 1.4 IMPORTANT FACTORS YOU SHOULD CONSIDER IN CHOOSING SILICONE GEL-FILLED BREAST IMPLANTS ................................................................. 12 2. BREAST IMPLANT COMPLICATIONS................................................................................... 14 2.1 WHAT ARE THE POTENTIAL COMPLICATIONS? ......................................................... 14 2.2 WHAT ARE OTHER REPORTED CONDITIONS? ........................................................... 19 3. ALLERGAN* CORE STUDY RESULTS .................................................................................. 22 3.1 OVERVIEW OF ALLERGAN’S CORE STUDY................................................................. 22 3.2 WHAT WERE THE 4-YEAR FOLLOW-UP RATES? ........................................................ 22 3.3 WHAT WERE THE BENEFITS? ...................................................................................... -
310-C, Breast Reconstruction After Mastectomy
AHCCCS MEDICAL POLICY MANUAL SECTION 310– COVERED SERVICES 310-C - BREAST RECONSTRUCTION AFTER MASTECTOMY EFFECTIVE DATES: 10/01/94, 11/27/18 REVISION DATES: 10/01/99, 10/01/01, 05/01/06, 10/01/06, 01/01/11, 09/27/18 I. PURPOSE This Policy applies to AHCCCS Complete Care (ACC), ALTCS E/PD, DCS/CMDP (CMDP), DES/DDD (DDD), and RBHA Contractors; Fee-For-Service (FFS) Programs as delineated within this Policy including: Tribal ALTCS, the American Indian Health Program (AIHP); and all FFS populations, excluding Federal Emergency Services (FES). (For FES, see AMPM Chapter 1100). This Policy establishes requirements for breast reconstruction surgery following a Mastectomy. II. DEFINITIONS MASTECTOMY Removal of the entire breast through surgery. III. POLICY Breast reconstruction surgery for the purposes of breast reconstruction post-mastectomy is a covered service if the member is AHCCCS eligible. The member may elect to have breast reconstruction surgery immediately following the Mastectomy or may choose to delay breast reconstruction; however, the member shall be AHCCCS eligible at the time of breast reconstruction surgery. The type of breast reconstruction performed is determined by the physician in consultation with the member. A. COVERAGE POLICIES FOR BREAST RECONSTRUCTIVE SURGERY 1. Reconstruction of the affected and the contralateral unaffected breast following a medically necessary Mastectomy is considered an effective non-cosmetic procedure. Breast reconstruction surgery following Mastectomy for any medical reason is a covered service. 2. Medically necessary breast implant removal is a covered service. Replacement of breast implants is a covered service when the original implant was the result of a medically necessary Mastectomy.