Analysis of Survival and Recurrences for Patients with Breast Cancer Receiving Mastectomy with or without Breast Reconstruction
Charalampos Siotos, MD, Ricardo J. Bello, MD, MPH, Akachimere Uzosike, BS, David M. Euhus, MD, Michele A. Manahan, MD, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.
PURPOSE: Post-mastectomy breast reconstruction significantly improves quality-of-life among breast cancer survivors. However, some patients still report concerns over the impact of breast reconstruction on survival. This study aimed to estimate the association between breast reconstruction and overall survival among women who undergo mastectomy for breast cancer. METHODS:We analyzed data from our institution’s prospectively collected National Cancer Institute-Designated Comprehensive Cancer Center Tumor Registry. We compared mastectomy-only patients to post-mastectomy breast reconstruction patients. We built Kaplan-Meier curves for both groups and compared unadjusted survival statistics using Log-rank test. We then used Cox Proportional Hazards to adjust for potential confounders. RESULTS: : From 2000 to 2014, 2,599 women underwent mastectomy for breast cancer. Of these, 1,052 (40.5%) underwent mastectomy only and 1,547 (59.5%) also underwent breast reconstruction. Most reconstructions were autologous (65.1%), followed by implant-based (26.8%), and mixed (8.1%). Five-year survival among mastectomy-only patients was 83.6% (95% CI=80.9-86.0); 5-year survival among post-mastectomy patients who received breast reconstruction was 91.9% (95% CI=90.2-93.4). Kaplan-Meier curves showed that survival was better among women who underwent post-mastectomy breast reconstruction, compared to women who underwent mastectomy only (Log-rank test=p<0.001, Figure 1). However, a Cox Proportional Hazards model adjusting for cancer stage, patient age, smoking status, radiotherapy, chemotherapy, hormone therapy, and axillary lymph node status did not show any evidence of a survival benefit for breast reconstruction (Hazard Ratio=0.80; 95% CI=0.60-1.08; p=0.1500). Estimates comparing mastectomy and breast reconstruction to mastectomy only patients showed lower risk for cancer recurrence in patients who underwent breast reconstruction (Adjusted Hazard Ratio=0.68, 95% CI=0.48-0.96, p=0.030).CONCLUSION: Our results demonstrate that breast reconstruction does not negatively impact patient survival. In fact, risk of developing recurrences over time may be lower in breast reconstruction patients. Improved survival outcomes observed for this self-selected patient population are likely due to other patient and treatment characteristics. However, these data may be helpful to surgical oncologists and plastic surgeons and reassuring to patients when discussing the safety and survival outcomes related to breast reconstruction.
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