Analysis of Survival and Recurrences for Patients with Breast Cancer Receiving Mastectomy with or without Breast Reconstruction
Charalampos Siotos, MD, Ricardo J. Bello, MD, Michele A. Manahan, MD, David M. Euhus, 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 survival data from a prospectively-kept institutional breast cancer registry, comparing mastectomy-only patients to post-mastectomy breast reconstruction patients. We built Kaplan-Meier curves for both groups and compared unadjusted survival statistics using Logrank test. We used Cox Proportional Hazards to adjust for potential confounders.
Results: 2,599 women underwent mastectomy for breast cancer during 2000-2014. 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%). Survival was significantly improved among women who underwent post-mastectomy breast reconstruction, compared to women who underwent mastectomy only (figure 1; p<0.001). However, this was no longer significant after adjusting for stage, patient age, smoking status, radiotherapy, chemotherapy, hormone therapy, and axillary lymph node status (HR: 0.87; 95% CI: 0.67-1.13; p=0.320).
Conclusions: Breast reconstruction does not negatively impact patient survival. On the contrary, breast reconstruction patients showed improved survival in unadjusted analysis. Surgical oncologists and plastic surgeons should reassure breast cancer patients that breast reconstruction is a safe option for them with potential to improve their quality-of-life.
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