Plastic Surgery Research Council

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Clinical Factors Influencing Breast Reconstruction in Post Mastectomy Breast Cancer Patients
Ishan Mehta, Christopher Tokin, Thomas O'Keefe, Anne Wallace.
University of California San Diego, San Diego, CA, USA.

PURPOSE:
Post mastectomy breast reconstruction has been shown to positively affect subjective individual well-being. Despite this, little is known about the factors impacting the decision to undergo reconstruction. Additionally, information regarding reconstruction is commonly impacted by common misconceptions and anecdotal experience which can compromise optimal clinical care. The objectives of this study were to further investigate and characterize clinical factors that affect the odds for undergoing reconstruction after mastectomy as well as to develop a predictive model to identify factors contributory toward reconstruction.
METHODS:
Consecutive female patients diagnosed with breast cancer, between 2000 and 2017 were identified in a single-institution database and enrolled in this retrospective study. Chi-squared testing was employed to examine differences across rates of reconstruction while controlling for several factors including: age, race, neoadjuvant therapy, grade of differentiation, chemotherapy, radiation therapy, and type of insurance. A logistic regression model was developed to identify factors predictive of reconstruction.
RESULTS:
From 2000-2017, 5,890 patients met eligibility criteria and were enrolled in this study. Mean age was 57.6 years and the participants were predominantly Caucasian (87%). Out of 5,910 participants, 3,831 (64.8%) underwent breast reconstruction. As shown in Table 1, significant variations in rates of breast reconstruction were found across patient age group (p = 0.005), grade of cancer (p < 0.0001), type of insurance (p = 0.001), use of chemotherapy (p = 0.002), and use of radiation (p = 0.0002). Notably no significant rate of breast reconstruction was found across race (p = 0.537) or use of neoadjuvant therapy (p = 0.665). Controlling for these factors, logistic regression analysis revealed that undifferentiated grade of cancer (OR: 0.67, p = 0.003) and patients with Medicare insurance (OR: 0.41, p < 0.0001) were the most predictive clinical factors for not undergoing reconstruction, whereas patients who received chemotherapy were actually more likely to undergo breast reconstruction. Interestingly, while rates of breast reconstruction after radiation treatment were high (62%), after controlling for other factors, radiation also became a negative predictor of breast reconstruction after mastectomy (OR 0.72, p < 0.0001)
CONCLUSION:
Independent of treatment modality, poor tumor grade seems to be an important factor in predicting breast reconstruction rates at our institution. Further work is necessary to elucidate why this relationship holds true for surgical treatment independent of more aggressive medical treatment of breast cancer.


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