Oncologic Outcomes after Immediate Breast Reconstruction Following Total Mastectomy in Patients with Breast Cancer: A Matched Case-Control Study

Abstract

PurposeThe use of immediate breast reconstruction (IBR) following total mastectomy (TM) has increased markedly in patients with breast cancer. As the indications for IBR have been broadened and more breast-conserving surgery-eligible patients are undergoing IBR, comparing the oncologic safety between TM only and IBR following TM becomes more difficult. This study aimed to analyze the oncologic outcomes between TM only and IBR following TM via a matched case-control methodology.MethodsA retrospective review was conducted to identify all patients who underwent TM between 2008 and 2014. We excluded patients who underwent neoadjuvant chemotherapy, including palliative chemotherapy, and had a follow-up duration <12 months, inflammatory breast cancer, or incomplete data. We divided the remaining patients into two groups: those who underwent TM only (control group) and those who underwent IBR following TM (study group). The groups were propensity score-matched. Matched variables included age, pathologic stage, estrogen or progesterone receptor status, human epidermal growth factor receptor 2 status, and year of operation.ResultsAfter matching, 878 patients were enrolled in the control group and 580 patients in the study group. The median follow-up duration was 43.4 months (range, 11–100 months) for the control group and 41.3 months (range, 12–100 months) for the study group (p=1.000). The mean age was 47.3±8.46 years for the control group and 43.9±7.14 years for the study group (p>0.050). Matching was considered successful for the matching variables and other factors, such as family history, histology, multiplicity, and lymphovascular invasion. There were no significant differences in overall survival (log-rank p=0.454), disease-free survival (log-rank p=0.186), local recurrence-free survival (log-rank p=0.114), or distant metastasis-free survival rates (logrank p=0.537) between the two groups.ConclusionOur results suggest that IBR following TM is a feasible treatment option for patients with breast cancer.

Postoperative outcomes of breast reconstruction after mastectomy

“…[ 19 , 20 ] In the present study, multivariate analysis show that the independent factors of prognosis were tumor stage, estrogen receptor/progestrone receptor status, and Her2 status. Our results coincide with those of other matched case–control studies, [ 5 , 21 ] suggesting that breast reconstruction is an oncologically safe procedure, whether it is autogenous tissue reconstruction, implant reconstruction, immediate breast reconstruction or delayed reconstruction.…”

Does Chemotherapy or Radiotherapy Affect for Postoperative Complication in Patients Who Underwent Immediate Breast Reconstruction With Tissue Expander?

“…Because insurance has covered breast reconstruction for breast cancer patients since April 2015 in Korea, patients have been able to select immediate breast reconstruction more easily. Several studies have demonstrated oncologic safety in the patients who underwent IR following mastectomy [11][12][13]. In addition, the majority of previous studies on the impact of chemotherapy or radiotherapy on postoperative complications after immediate breast reconstruction reported that chemotherapy or radiotherapy did not increase postoperative complications and immediate breast reconstruction did not affect the initiation of adjuvant treatment [3,[7][8][9][10][14][15][16][17][18][19][20][21].…”

“…Several previous studies have reported oncologic safety and no difference in complications after IR following mastectomy in patients with breast cancer [11][12][13]. However, many surgeons still hesitate to perform immediate breast reconstruction for patients with high-stage breast cancer.…”

Does chemotherapy or radiotherapy affect the postoperative complication in patients who underwent immediate breast reconstruction with tissue expander?

“…Breast cancer patients have been able to select immediate breast reconstruction more easily without worrying cost because insurance has covered breast reconstruction for breast cancer patients since April 2015 in Korea. Several studies have demonstrated oncologic safety in the patients who underwent IR following mastectomy [15][16][17]. In addition, the majority of previous studies on the impact of chemotherapy or radiotherapy on postoperative complications after immediate breast reconstruction reported that chemotherapy or radiotherapy did not increase postoperative complications and immediate breast reconstruction did not affect the initiation of adjuvant treatment [5,[9][10][11][12][18][19][20][21][22][23][24][25].…”

“…Several previous studies have reported oncologic safety and no difference in complications after IR following mastectomy in patients with breast cancer [15][16][17]. However, many surgeons still hesitate to perform immediate breast reconstruction for patients with high-stage breast cancer.…”