Introduction: Locoregional (LR) cancer recurrence following mastectomy has been associated with a decreased disease-specific survival. Complex or invasive procedures such as open abdominal procedures have been shown to result in immune suppression when compared to simple procedures such as laparoscopy. Given this background, it has been hypothesized that autogenous tissue breast reconstruction may result in immunosuppression and an increased risk of LR cancer recurrence. The purpose of this study was, therefore, to evaluate the influence of autogenous tissue reconstruction on the incidence and detection of LR recurrence following mastectomy for invasive breast cancer.

Methods: A matched-retrospective cohort study was performed. Two patient cohorts were identified: i) patients who underwent mastectomy and immediate, autologous tissue reconstruction; and, ii) patients who underwent mastectomy alone. Only patients with at least 20 months of follow-up and/or patients who had recurrence within 20 months of their primary cancer were included. Patients were excluded if they had: LCIS/DICS only, sarcoma or phyllodes; stage IV disease at presentation; synchronous bilateral cancer; and/or history of previous breast cancer. The Kaplan-Meier life table method was used to calculate recurrence-free survival rates. Differences in recurrence-free survival in the reconstructed and non-reconstructed cohorts were estimated using the generalized log-rank test. The Mann-Whitney test was used to compare continuous variables. Statistical significance was set at the p<0.05 level.

Results: In total, 188 patients who underwent mastectomy for invasive breast cancer from 1995 until 2004 were evaluated. Ninety-nine patients who had immediate autologous tissue reconstruction were matched to 99 women who underwent mastectomy alone. Patients were matched 1:1 on the basis of age (+/- 5 years) and breast cancer stage. Median follow-up for the entire cohort was 4.7 years (range, 1.6-11.1 yrs). The incidence of LR recurrence following mastectomy was 9.1 % in patients who had autogenous reconstruction and 9.1 % in patients who did not have reconstruction [p (logrank) = 0.376] (Figure 1). Median time to detection of a LR recurrence was 2.5 years (range, 1.0-9.3 ) in the reconstructed cohort and 2.1 years (range, 1.0-4.5) in the non-reconstructed cohort (p=0.270). There was similarly no difference in ‘LR recurrence +/-distant recurrence-free' survival between cohorts [p (logrank) =0.661]. Estimated 2- and 5- year ‘LR recurrence-free' survival was estimated at 93.7% and 85.9%, respectively in the non-reconstructed cohort and 95.6% and 83.2% in the reconstructed cohort.

Conclusion: Based on the results of this study, it appears that there is no difference in the incidence of locoregional breast cancer recurrence in patients who undergo immediate, autogenous tissue reconstruction compared to those patients who do not have reconstruction. In addition, these results suggest that postmastectomy autogenous tissue reconstruction does not hinder detection of LR breast cancer recurrence.

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