Sunday, October 3, 2010
17557

Immediate Post-Mastectomy Reconstruction Is Associated with Improved Breast Cancer-Specific Survival

Michael Bezuhly, MD, MSc, SM, Plastic Surgery, Dalhousie University, 1465 Brenton Street, Apt 1002, Halifax, NS B3J 3T3, Canada, Claire Temple, MD, Plastic Surgery, University of Western Ontario, Leif J. Sigurdson, MD, MSc, MBA, Plastic Surgery, University of Manitoba, Roger B. Davis, ScD, Harvard University, Gordon Flowerdew, ScD, Community Health and Epidemiology, Dalhousie University, and E. Francis Cook, ScD, Epidemiology, Harvard University.

PURPOSE Although immediate breast reconstruction is increasingly offered as part of post-mastectomy psychosocial rehabilitation, concerns remain that it may delay adjuvant therapy or impair detection of local recurrence. No single population-based study has examined the relationship between immediate breast reconstruction and breast cancer-specific survival.

METHODS Using data from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries, breast cancer-specific survival was compared for female unilateral mastectomy patients who did or did not undergo immediate breast reconstruction using Cox proportional hazards models. Models were fitted adjusting for known demographic and disease severity variables, and stratifying on reconstruction type (implant or autologous) and age.

RESULTS Improved breast cancer-specific survival was observed among all immediate breast reconstruction patients compared to patients who underwent mastectomy alone (hazard ratio [HR]=0.74; 95% CI, 0.68 to 0.80). Implant reconstruction patients below 50 years of age demonstrated the greatest apparent survival benefit (HR=0.47; 95% CI 0.28 to 0.80). Similarly, autologous reconstruction was associated with improved cancer-specific survival among patients below the age of 50 (HR=0.58; 95% CI 0.42 to 0.80) and between ages 50 to 69 (HR=0.61; 95% CI 0.43 to 0.85).

CONCLUSION Immediate breast reconstruction is associated with decreased breast cancer-specific mortality, particularly among younger women. We believe this association is more likely attributable to imbalances in socioeconomic factors and access to care than to inadequate adjustment for tumor characteristics and disease severity. Further research is needed to identify additional prognostic factors responsible for the improved cancer survival among women undergoing immediate post-mastectomy reconstruction.

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