The Prognosis of Breast Cancer Patients after Mastectomy and Immediate Breast Reconstruction: A Meta-Analysis

Yang, Xue; Zhu, Chenfang; Gu, Yan

doi:10.1371/journal.pone.0125655

Cited by 49 publications

(28 citation statements)

References 44 publications

(42 reference statements)

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“…In contrast to mastectomy, IBR has been shown to provide better cosmetic outcome and superior quality of life, without compromising oncological safety (2)(3)(4)(5)(6)(7)(9)(10)(11)(12)(13)(40)(41)(42)(43)(44).…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

et al. 2017

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Background: Immediate breast reconstruction (IBR) after mastectomy has shown to be oncologically safe and to improve quality of life in breast cancer patients. However, most women undergoing mastectomy do not undergo IBR. In this study, we aim to identify breast surgeon-related factors in considering IBR and factors affecting patients' decision to choose for IBR.Methods: Retrospective analysis of the records of breast cancer patients who underwent mastectomy with or without IBR between 2010 and 2013. We documented all information whether or not a patient underwent IBR after mastectomy.Results: Of 437 patients, 97 (22.2%) underwent IBR, 89.8% of which received tissue expanders. Patient who did not undergo IBR had a higher age (62.2 versus 51.9 years, P<0.001) and higher body mass index (BMI) (27.0 versus 24.3, P<0.001). Hundred three patients declined IBR, mainly because considering reconstruction as too much trouble. In 128 cases the breast surgeon did not offer IBR, mostly because of the predicted need for post mastectomy radiation. Approximately 11% of the patients were not informed about IBR.Conclusions: Anticipated radiation therapy, higher age and higher BMI were important breast surgeonrelated factors in refraining from IBR. Almost one third of all patients declined IBR. In almost 10% of all patients, IBR was not discussed.Keywords: Breast neoplasms; breast reconstruction; decision making; mammaplasty; mastectomy Submitted Aug 11, 2016. Accepted for publication Oct 27, 2016Oct 27, . doi: 10.21037/gs.2016 View this article at: http://dx.doi.org/10.21037/gs.2016.11.11 44 Weenk et al. Decision-making process in IBR © Gland Surgery. All rights reserved.Gland Surg 2017;6(1):43-48 gs.amegroups.com States. In 2000, 12.9% of all mastectomies performed in the United States were combined IBR, increasing to 36.3% in 2009 (15). The United Kingdom Association of Breast Surgery recommends that any patient in which IBR is oncologically safe should have the possibility to choose for IBR (16). Dutch guidelines state IBR has a slight preference instead of delayed reconstruction and that every patient considered for mastectomy has to be informed about reconstructive options (17). However, despite the evidence and recommendations, almost two thirds of the mastectomies are still performed without IBR. We asked ourselves if there are elements in the pre-operative process that could facilitate or impede the choice for IBR. The major objective of this study was to investigate the decision-making process on whether or not a patient undergoes immediate reconstruction after mastectomy. In this study we focused on the role of patient as well as the role of the breast surgeon. MethodsWe investigated all electronic patient files of women diagnosed with DCIS or invasive carcinoma between 2010 and 2013, and underwent a mastectomy at the Canisius Wilhelmina Breast Center in Nijmegen, the Netherlands. Patients who underwent prophylactic mastectomy were excluded. IBR is defined as mastectomy and reconstruction performed on the same day. ...

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Section: Discussionmentioning

confidence: 99%

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

et al. 2017

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“…In order not to lose the skin envelope after skin-sparing mastectomy, one can place a spacer until completion of adjuvant therapy. Nonetheless, IBR is advantageously associated with a reduced recovery time, a better esthetic outcome, an improved quality of life, and, finally, lower surgery- and recovery-related costs ( 16 – 18 ).…”

Section: Reconstruction Techniques Of the Breastmentioning

confidence: 99%

Breast Reconstruction after Mastectomy

2016

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Breast cancer is the leading cause of cancer death in women worldwide. Its surgical approach has become less and less mutilating in the last decades. However, the overall number of breast reconstructions has significantly increased lately. Nowadays, breast reconstruction should be individualized at its best, first of all taking into consideration not only the oncological aspects of the tumor, neo-/adjuvant treatment, and genetic predisposition, but also its timing (immediate versus delayed breast reconstruction), as well as the patient’s condition and wish. This article gives an overview over the various possibilities of breast reconstruction, including implant- and expander-based reconstruction, flap-based reconstruction (vascularized autologous tissue), the combination of implant and flap, reconstruction using non-vascularized autologous fat, as well as refinement surgery after breast reconstruction.

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“…However, these procedures may compromise the completeness of mastectomy, and concerns have been raised about their oncologic safety. Due to these concerns, numerous groups have reported long-term follow-up results, demonstrating comparable or even better survival in patients who underwent immediate breast reconstruction compared to those who underwent conventional mastectomy alone [ 1 2 3 5 6 7 ]. However, many of these reports lack an appropriate matched case-control group and compare survival rates with those reported in previous studies.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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The Prognosis of Breast Cancer Patients after Mastectomy and Immediate Breast Reconstruction: A Meta-Analysis

Cited by 49 publications

References 44 publications

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

Breast Reconstruction after Mastectomy

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

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