Background Matrices are now commonly used in breast reconstruction, but the scientific evidence is still scares. The main aim was to compare complications and the need for corrections in immediate breast reconstruction with the porcine-derived Surgisis ® with the traditional muscle-covered technique. The secondary aim was to compare long-term quality of life and satisfaction. Methods All consecutive patients who had their breast reconstructed with a Surgisis ® or muscle-covered tissue expander/implant were included. Patients were followed clinically and with BREAST-Q. Results During the study period, 116 reconstructions (71 patients) were operated in the Surgisis ® group and 132 reconstructions (90 patients) in the control group. The median follow-up time was 74 months (min 43-max 162). The total early complication rate was 37% in the Surgisis ® group and 27% in the control group. There were no differences in implant loss (p = 0.68) or total number of complications (p = 0.24) between the two groups. Risk factors for complications were mainly patient characteristics and the use of a tissue expander. There was a slightly higher capsular contracture frequency in the Surgisis ® patients (4.2% vs. 2.5%). The need for corrections and patient satisfaction and quality of life were similar in the two groups. Conclusions The use of Surgisis ® in implant-based reconstruction seems to result in an acceptable total early complication rate. The rate might be higher in tissue expander-based reconstruction. Risk factors are mainly patient characteristics. The capsular contracture rate and need for corrections, as well as patient satisfaction and quality of life, are similar in the Surgisis ® patients and muscle-covered controls. Level of evidence: III

IntroductionBreast cancer (BC) is one of the leading causes of death among women worldwide. Immunostimulatory treatment has increasingly been used as adjuvant therapy in the last few years, in patients with melanoma and other cancer forms, often with an induction of autoimmunity as a consequence of a successful treatment. We aimed at investigating if coexisting autoimmune diseases (AD) or hypersensitivities (HS) similarly to the side effects of immunostimulatory treatment resulted in a better overall survival, compared to patients without these disorders.Material and methodsThe patient material used was a consecutive clinical material consisting of 1705 patients diagnosed with BC between 1980 and 2010 in Sweden. The patients were stratified according to coexisting AD, HS or lack of both. Overall survival was calculated using Kaplan-Meier and the Cox proportional hazard model.ResultsOur main finding was that BC patients with estrogen receptor (ER) negative tumors together with preexisting AD or HS had a statistically significant better overall survival (HR=0.53; 95% CI= 0.30-0.96) compared to patients without. Premenopausal BC patients with a coexistence of AD or HS had a better overall survival, but this was not statistically significant.DiscussionFor patients with premenopausal or ER-negative BC, coexistence with AD or HS was associated with a better overall survival. Although these findings require validation, and the mechanisms responsible need to be found, they hint to possible new treatment strategies for BC, especially for those with ER-negative tumors and potentially for premenopausal patients.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-357) contains supplementary material, which is available to authorized users.

1594 Background: Antibody therapy of malignant melanoma with ipilimumab is associated with the development of an autoimmune disease. The aim was to investigate if preexisting autoimmune disorders or hypersensitivities, similar to the side effects of immunotherapy in malignant melanoma, gave a better overall survival for breast cancer (BC) patients, compared with patients without these disorders. Methods: A consecutive clinical material consisting of 1,705 breast cancer patients diagnosed between 1980 and 2010 was used. The patients were grouped according to preexisting autoimmune disease or hypersensitivities. The remaining BC patients were used as a reference group. All analyses were adjusted for age at diagnosis, T, N, M-status of the tumor, and ever-use of HRT simultaneously. A p value of less than 0.05 was considered significant. Results: One hundred and twenty-five (7.3%) patients had a history of autoimmunity and 72 (4.2%) patients had a history of hypersensitivity prior to BC diagnosis. Our main finding was that BC patients with a preexisting autoimmune disease or hypersensitivities with ER-negative tumors had a longer overall survival compared to patients without, HR 0.55, 95% CI 0.31-0.97. The risk was specifically low in BC patients with hypersensitivity and ER-negative tumors, HR 0.39, 95% CI 0.16-0.96. The risk was nonsignificantly lower in the autoimmune group, HR 0.78, 95% CI 0.37-1.61. Stratifying both on ER-status and menopausal status, similar results were seen in premenopausal BC patients with hypersensitivity. Postmenopausal BC patients with an ER-negative tumor and an autoimmune disease had a longer nonsignificant overall survival, HR 0.3, 95% CI 0.07-1.26. Conclusions: BC patients with an ER-negative tumor and/or diagnosed before menopause had a longer overall survival when previously diagnosed with hypersensitivity. For BC patients with an autoimmune disease, the prognostic benefit was seen when diagnosed postmenopausally with an ER-negative BC. Preexisting or induced autoimmunity or hypersensitivity may prolong life in breast cancer especially in young patients and those with ER-negative tumors.