Albornoz, Claudia R et al
Plastic & Reconstructive Surgery: June 2015 - Volume
135 - Issue 6 - p 1518–1526
doi: 10.1097/PRS.0000000000001276
Background: Although
breast-conserving surgery is oncologically safe for women with early-stage
breast cancer, mastectomy rates are increasing. The objective of this study was
to examine the role of breast reconstruction in the surgical management of
unilateral early-stage breast cancer.
Methods: A retrospective cohort study of
women diagnosed with unilateral early-stage breast cancer (1998 to 2011)
identified in the National Cancer Data Base was conducted. Rates of
breast-conserving surgery, unilateral and bilateral mastectomy with
contralateral prophylactic procedures (per 1000 early-stage breast cancer
cases) were measured in relation to breast reconstruction. The association
between breast reconstruction and surgical treatment was evaluated using a
multinomial logistic regression, controlling for patient and disease
characteristics.
Results: A total of 1,856,702 patients were included.
Mastectomy rates decreased from 459 to 360 per 1000 from 1998 to 2005 (p <
0.01), increasing to 403 per 1000 in 2011 (p < 0.01). The mastectomy rates
rise after 2005 reflects a 14 percent annual increase in contralateral
prophylactic mastectomies (p < 0.01), as unilateral mastectomy rates did not
change significantly. Each percentage point of increase in reconstruction rates
was associated with a 7 percent increase in the probability of contralateral
prophylactic mastectomies, with the greatest variation explained by young
age(32 percent), breast reconstruction (29 percent), and stage 0 (5 percent).
Conclusions: Since 2005, an increasing proportion of early-stage breast cancer
patients have chosen mastectomy instead of breast-conserving surgery. This
trend reflects a shift toward bilateral mastectomy with contralateral
prophylactic procedures that may be facilitated by breast reconstruction
availability.
