Multi-center investigation of breast reconstruction after mastectomy from Chinese Society of Breast Surgery: A survey based on 31 tertiary hospitals (CSBrS-004)

Abstract

Objective Multi-center data on the current status and trends of breast reconstruction after mastectomy in China are lacking. Herein, we conducted a cross-sectional survey to investigate the current clinical practice pattern of postmastectomy breast reconstruction among Chinese female patients with breast cancer. Methods A standardized questionnaire used to collect information on breast reconstruction among females diagnosed with breast cancer was distributed by 31 members of the Chinese Society of Breast Surgery between January 1, 2018 and December 31, 2018. Information was collected on tumor characteristics, treatment, mesh application, nipple-areola complex (NAC) preservation, postoperative complications, bilateral reconstruction, patient satisfaction and local recurrence. The overall rate of breast reconstruction was assessed, and the characteristics were compared across patient groups with different reconstruction approaches. Results A total of 1,554 patients underwent breast reconstruction after total mastectomy, with a reconstruction rate of 9.6%. Among them, 1,190 were implant-based, and 262 underwent autologous reconstructions, while 102 cases underwent a combination of both. Patients who underwent implant-based reconstruction were younger than those who received autologous reconstruction (40.1±4.6 vs . 45.0±5.9, P=0.004). Compared to patients with autologous reconstruction, mesh application (25.5% vs . 6.5%), NAC preservation (51.8% vs . 40.5%) and reconstruction failure (1.8% vs . 0) were more frequently reported among those with implant-based reconstruction. There was no significant difference in general satisfaction across three reconstruction approaches, though patients with autologous reconstruction reported the highest aesthetic satisfaction among the three groups (P=0.044). Conclusions Implant-based breast reconstruction remains the dominant choice among patients, while autologous reconstruction was associated with higher aesthetic satisfaction. Our multi-center investigation based on the findings of the tertiary hospitals of Chinese Society of Breast Surgery may guide a future series of clinical studies on breast reconstruction in China.

Mastectomy and Immediate Breast Reconstruction with Pre-Pectoral or Sub- Pectoral Implant: Assessing Clinical Practice, Post-Surgical Outcomes, Patient’s Satisfaction and Cost

“…In England, the number of implant-IBR have increased since 2009: 10.0% until 2005 and 23.3% by 2013–2014 [ 9 ]. In Chinese, IBR rate was 9.6% (1,554/16,187) in year 2018, with implant or expander in 76.6% of these IBR [ 11 ]. However, the average rate of reconstruction in the United States in 2010 was 45%, surging to 54% in 2015 [ 35 ].…”

“…For risk reducing mastectomy, unilateral or bilateral mastectomies are indicated for BRCA mutations and for patients without BRCA mutation with estimated-risk of BC up to 25%. Immediate breast reconstruction (IBR) rates increase during the last years [ 7 ] in order to improve quality of life [ 8 ] and implant-based reconstruction was the most commonly performed procedure [ 9 – 11 ]. In our center, among 2112 mastectomies performed between January 2016 and July 2020, IBR-rate was 40.5%: 35.4% (618/1748) for primary BC, 47.9% (105/219) for local recurrence and 91% (132/145) for prophylactic mastectomies.…”

Postoperative Outcomes of Pre-Pectoral Versus Sub-Pectoral Implant Immediate Breast Reconstruction

“…As a result, the incidence of IBR has increased in recent decades. It was reported to be 9.6% in China in 2018 [ 12 ], 14% between 2011 and 2016 in France (INCa report), and increased from 10% at the beginning of the 2000s to 23.3% in the year 2014 in the UK [ 13 ]. In our cancer center, the rate assessed between 2008 and 2014 was 16.1% (similar to that reported at the French level) and increased to 40.5% between 2016 and 2020 [ 14 ].…”

The risk factors and the relationship between radiation dose and complications and prosthetic reconstruction failure in patients with post-mastectomy breast implant reconstruction: a retrospective cohort study

“…However, this may be improved by breast implant reconstruction ( 2 ), which has risen in popularity globally ( 3 ). While the number of patients undergoing reconstruction in China is less than that in some Western countries, the numbers have gradually increased in recent years ( 4 ).…”