Trends in and Factors Associated with Modality-Specific Immediate Breast Reconstruction in China: A 17-year Retrospective Cohort Study

BACKGROUND

The implant-based immediate breast reconstruction (IBR) after mastectomy for cancer has gained the momentum in contrast to the autologous procedure in the United States.^[1] However, there have been limited studies to date that clarify the modality-specific trends in China. Therefore, the aim of our retrospective cohort study is to determine the prevalence and predictors of implant-based versus autologous IBR among Chinese patients. 

METHODS

All female patients who underwent IBR after mastectomy from 2001 to 2017 at the largest breast cancer center in China were enrolled in the retrospective cohort. The annual trends in reconstruction rates, implant/autologous ratio, modality-specific hospital stay and healthcare charges were assessed. 12 variables consisting of sociodemographic characteristics and oncological features were evaluated through univariate and multivariate logistic regression modeling. The sensitivity and specificity of the regression models were tested by receiver operating characteristic (ROC) curve analysis. 

RESULTS

Among 905 patients included in the study (median age, 40 [IQR, 35-45] years; median BMI, 22.48 [IQR, 20.58-24.43]), 479 (52.9%) patients received implant-based IBR and 426 (47.1%) underwent the autologous procedure. The number of IBR cases and the reconstruction rates rose significantly from 6 (0.55%) in 2001 to 142 (35.02%) in 2017. The average hospital stay decreased remarkably from 26 (IQR, 19.25-27.5) days in 2001 to 21 (IQR, 16-25) days in 2017 (p < 0.01). A notable paradigm shift from autologous to implant-based IBR was revealed with implant/autologous ratio increasing from 0 in 2001 to 3.33 in 2017. The hospitalization expenses of autologous-based IBR were significantly lower than that of implant-based procedure (p < 0.05), but they have approached the level of implant-based charges in 2017. Multivariable analysis showed that unmarried patients with BMI ≤ 24 kg/m², earlier clinical tumor stage, and preoperative pathological diagnosis of non-invasive lesion are more likely to have implant-based than autologous reconstruction. The models performed well in predicting the decision on type of reconstruction among the current cohort patients (areas under ROC curve, 0.766; 95%CI, 0.725-0.806). 

CONCLUSION

The current study confirms that the implant-based paradigm is the predominant form of immediate postmastectomy breast reconstruction in China. The BMI, marital status, clinical tumor staging and preoperative pathological diagnosis strongly affect the choice of breast reconstruction modality. Our results may assist both surgeons and patients in making high-quality and individualized decision on the type of IBR. 

REFERENCE

1          Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg, 2013, 131(1): 15-23.