Comparison of outcomes between immediate implant-based and autologous reconstruction: 15-year, single-center experience in a propensity score-matched Chinese cohort

Abstract

Objective: The number of immediate breast reconstruction (IBR) procedures has been increasing in China. This study aimed to investigate the oncological safety of IBR, and to compare the survival and surgical outcomes between implant-based and autologous reconstruction. Methods: Data from patients diagnosed with invasive breast cancer who underwent immediate total breast reconstruction between 2001 and 2016 were retrospectively reviewed. Long-term breast cancer-specific survival (BCSS), disease-free survival (DFS), and locoregional recurrence-free survival (LRFS) were evaluated. Patient satisfaction with the breast was compared between the implantbased and autologous groups. BCSS, DFS, and LRFS were compared between groups after propensity score matching (PSM). Results: A total of 784 IBR procedures were identified, of which 584 were performed on patients with invasive breast cancer (implantbased, n = 288; autologous, n = 296). With a median follow-up of 71.3 months, the 10-year estimates of BCSS, DFS, and LRFS were 88.9% [95% confidence interval (CI) (85.1%-93.0%)], 79.6% [95% CI (74.7%-84.8%)], and 94.0% [95% CI (90.3%-97.8%)], respectively. A total of 124 patients completed the Breast-Q questionnaire, and no statistically significant differences were noted between groups (P = 0.823). After PSM with 27 variables, no statistically significant differences in BCSS, DFS, and LRFS were found between the implant-based (n = 177) and autologous (n = 177) groups. Further stratification according to staging, histological grade, lymph node status, and lymph-venous invasion status revealed no significant survival differences between groups. Conclusions: Both immediate implant-based and autologous reconstruction were reasonable choices with similar long-term oncological outcomes and patient-reported satisfaction among patients with invasive breast cancer in China.

Novel nomograms for predicting survival for immediate breast reconstruction patients diagnosed with invasive breast cancer—a single-center 15-year experience

“…Although, clinically, no differences in oncological outcomes were reported when comparing patients receiving modified radical mastectomy (MRM) with patients undergoing MRM with immediate reconstruction ( 15 , 16 ), considerable debate exists whether complications following reconstruction may delay adjuvant therapies that can have a negative impact on oncologic outcomes. We have previously demonstrated no differences in oncological outcomes comparing implant-based and autologous breast reconstruction in a propensity score-matched setting ( 5 ). The present study expands on our previous work demonstrating factors that can compromise BCSS and DFS in patients who have undergone immediate reconstruction, and also allowed construction and validation of novel nomograms to predict individual BCSS and DFS.…”

“…Although scientific studies posed oncological concerns that immediate reconstruction may change regional microenvironment, prolong surgical duration, delay the initiation of subsequent adjuvant therapy, and potentially lead to cancer recurrence, numerous clinical reports were published on the outcomes of immediate breast reconstruction following mastectomy and most supported its long-term oncological safety ( 2 – 4 ) compared to mastectomy alone. Our previous studies have demonstrated similar breast cancer-specific survival (BCSS) and local regional control between immediate implant-based and autologous breast reconstructions ( 5 ). The present study aims to investigate risk factors associated with the survival outcomes in breast cancer patients with invasive disease.…”