Oncologic Safety of Immediate Breast Reconstruction for Invasive Breast Cancer Patients: A Matched Case Control Study

Abstract

PurposeThe purpose of this study was to compare locoregional recurrence-free survival (LRFS) and disease-free survival (DFS) between patients undergoing mastectomy and immediate breast reconstruction (IBR) and those undergoing mastectomy alone.MethodsA retrospective review of patients who underwent mastectomy and immediate breast reconstruction for resectable invasive breast cancer between 2002 and 2010 at a single center was conducted. These cases were matched to patients who underwent mastectomy alone in the same time period, performed by 1:2 matching. Matching control variables included age, tumor size, axillary lymph node metastasis, and estrogen receptor status. Overall, 189 patients were identified in the IBR group, and 362 patients were matched to this group.ResultsIn the IBR group, 75 patients (39.7%) underwent conventional total mastectomy, 78 (41.3%) underwent skin-sparing mastectomy (SSM), and 36 (19.0%) underwent nipple-sparing mastectomy (NSM). The IBR group was significantly younger than the control group (41.9 and 45.1 years, respectively) (p=0.032), in spite of matching between three age groups. The DFS rates were similar between the IBR group and mastectomy alone group, at 92.0% and 89.9%, respectively, at 5-year follow-up (log-rank test, p=0.496). The 5-year LRFS was 96.2% in the IBR group and 96.4% in the mastectomy alone group (log-rank test, p=0.704), similar to data from previous reports. Subgroup analyses for SSM or NSM patients showed no differences in LRFS and DFS between the two groups. Additionally, in stage III patients, IBR did not cause an increase in recurrence.ConclusionIBR after mastectomy, including both SSM and NSM, had no negative impact on recurrence or patient survival, even in patients with advanced disease.

Postoperative outcomes of breast reconstruction after mastectomy

“…There have been a few matched case–control studies have reported no difference in oncologic outcomes between different types of breast reconstruction, oncologic outcomes was mainly related to the biological characteristics and stages of tumor. [ 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.…”

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

“…Disproportionate hormonal status and unknown HER2 status may affect the OS and BCSS. Recently, Park et al [27] compared the oncologic outcomes between TM only and IBR following TM in a population matched by age, tumor size, axillary LN metastasis, and ER status between 2002 and 2010. The median follow-up duration was 65.6 months (range, 10–132 months) in the IBR group and 81.1 months (range, 1–154 months) in the TM only group ( p <0.001).…”

Oncologic outcomes after immediate breast reconstruction following mastectomy: comparison of implant and flap using propensity score matching

“…Although recent reports suggest that IBR does not affect cancer recurrence or detection [3,5,18] there are still oncologic concerns about the use of flap reconstruction [19]. There are no affirmative data comparing locoregional recurrence rates between implant-based reconstruction and flap reconstruction.…”