by Siotos, Charalampos;
Naska, Androniki; Bello, Ricardo J.; Uzosike, Akachimere; Orfanos, Philippos;
Euhus, David M.; Manahan, Michele A.; Cooney, Carisa M.; Lagiou, Pagona;
Rosson, Gedge D.
Background: Concerns have been expressed about the oncologic safety of breast
reconstruction following mastectomy for breast cancer. This study aimed to
evaluate the association of breast reconstruction with breast cancer
recurrence, and 5-year survival among breast cancer patients. Methods: The
authors analyzed data from The Johns Hopkins Hospital comprehensive cancer
registry, comparing mastectomy-only to postmastectomy breast reconstruction in
breast cancer patients to evaluate differences in breast cancer recurrence and
5-year survival. Kaplan-Meier curves were used to compare unadjusted estimates
of survival or disease recurrence. Data were modeled through Cox proportional
hazards regression, using as outcomes time to death from any cause or time to
cancer recurrence.
Results: The authors analyzed data on 1517 women who underwent mastectomy for
breast cancer at The Johns Hopkins hospital between 2003 and 2015. Of these,
504 (33.2 percent) underwent mastectomy only and 1013 (66.8 percent) underwent
mastectomy plus immediate breast reconstruction. Women were followed up for a
median of 5.1 years after diagnosis. There were 132 deaths and 100 breast
cancer recurrences. A comparison of Kaplan-Meier survival estimates
demonstrated a survival benefit among patients undergoing mastectomy plus
reconstruction. After adjusting for various clinical and socioeconomic
variables, there was still an overall survival benefit associated with breast
reconstruction which, however, was not statistically significant (hazard ratio,
0.78; 95 percent CI, 0.53 to 1.13). Patients who underwent reconstruction had a
similar rate of recurrence compared to mastectomy-only patients (hazard ratio,
1.08; 95 percent CI, 0.69 to 1.69).
Conclusion:
This study suggests that breast reconstruction does not have a negative impact
on either overall survival or breast cancer recurrence rates. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
