J Breast Cancer.  2017 Mar;20(1):74-81. 10.4048/jbc.2017.20.1.74.

Oncologic Outcomes after Immediate Breast Reconstruction Following Total Mastectomy in Patients with Breast Cancer: A Matched Case-Control Study

• Ryu JM
• Paik HJ
• Park S
• Yi HW
• Nam SJ
• Kim SW
• Lee SK
• Yu J
• Bae SY
• Lee JE

• KMID: 2379401
• DOI: http://doi.org/10.4048/jbc.2017.20.1.74

Abstract

PURPOSE
The use of immediate breast reconstruction (IBR) following total mastectomy (TM) has increased markedly in patients with breast cancer. As the indications for IBR have been broadened and more breast-conserving surgery-eligible patients are undergoing IBR, comparing the oncologic safety between TM only and IBR following TM becomes more difficult. This study aimed to analyze the oncologic outcomes between TM only and IBR following TM via a matched case-control methodology.
METHODS
A retrospective review was conducted to identify all patients who underwent TM between 2008 and 2014. We excluded patients who underwent neoadjuvant chemotherapy, including palliative chemotherapy, and had a follow-up duration <12 months, inflammatory breast cancer, or incomplete data. We divided the remaining patients into two groups: those who underwent TM only (control group) and those who underwent IBR following TM (study group). The groups were propensity score-matched. Matched variables included age, pathologic stage, estrogen or progesterone receptor status, human epidermal growth factor receptor 2 status, and year of operation.
RESULTS
After matching, 878 patients were enrolled in the control group and 580 patients in the study group. The median follow-up duration was 43.4 months (range, 11-100 months) for the control group and 41.3 months (range, 12-100 months) for the study group (p=1.000). The mean age was 47.3±8.46 years for the control group and 43.9±7.14 years for the study group (p>0.050). Matching was considered successful for the matching variables and other factors, such as family history, histology, multiplicity, and lymphovascular invasion. There were no significant differences in overall survival (log-rank p=0.454), disease-free survival (log-rank p=0.186), local recurrence-free survival (log-rank p=0.114), or distant metastasis-free survival rates (logrank p=0.537) between the two groups.
CONCLUSION
Our results suggest that IBR following TM is a feasible treatment option for patients with breast cancer.

Keyword

Breast neoplasms; Mammaplasty; Treatment outcome

MeSH Terms

Breast Neoplasms*
Breast*
Case-Control Studies*
Disease-Free Survival
Drug Therapy
Estrogens
Female
Follow-Up Studies
Humans
Inflammatory Breast Neoplasms
Mammaplasty*
Mastectomy, Simple*
Receptor, Epidermal Growth Factor
Receptors, Progesterone
Retrospective Studies
Survival Rate
Treatment Outcome
Estrogens
Receptor, Epidermal Growth Factor
Receptors, Progesterone

Figure

• 

  Figure 1 Schematic diagram of patient's selection for the matched study. TM=total mastectomy; NAC=neoadjuvant chemotherapy; F/U= follow-up; IBR=immediate breast reconstruction; NSM=nipple-sparing mastectomy; NNSM=non-NSM; ER=estrogen receptor; PR= progesterone receptor; HER2=human epidermal growth factor receptor 2.

• 

  Figure 2 Kaplan-Meier survival curves according to operation type for overall survival (A), disease-free survival (B), distant metastasis-free survival (C), and locoregional recurrence-free survival (D). TM=total mastectomy; IBR=immediate breast reconstruction.

• 

  Figure 3 Kaplan-Meier survival curves between nipple-sparing mastectomy (NSM) and non-NSM (NNSM) among the study group for overall survival (A), disease-free survival (B), distant metastasis-free survival (C), and locoregional recurrence-free survival (D).

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