Abstract
A large proportion of patients with breast cancer who had mastectomy had undergone breast reconstruction with implants or autologous flaps. However, only a few studies have compared the breast cancer outcomes between the implant-based reconstruction (IBR) and autologous flap reconstruction (AFR). In this study, we retrospectively compared the local recurrence rates, distant metastasis rates, and survival outcomes between immediate IBR and AFR. A total of 1530 patients with primary breast cancer who underwent IBR or AFR with nipple-/skin-sparing mastectomy were included. Patients who underwent neoadjuvant systemic therapy were excluded from the study. After propensity score matching by age at diagnosis, T stage, N stage, molecular subtype, mastectomy type, adjuvant radiotherapy status, and follow-up period, 938 patients were 1:1 matched, comprising the well-balanced IBR and AFR groups. Locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and breast cancer-specific survival (BCSS) were compared between the matched groups. After matching, the median follow-up periods were 68months and 71months for the IBR and AFR groups, respectively. No significant differences were observed between the IBR and AFR groups regarding the local recurrence (7.2% vs. 5.1%; P = 0.175), regional recurrence (2.1% vs. 1.5%; P = 0.463), or distant metastasis (3.2% vs. 3.2%; P = 1.000) rates. Moreover, no significant difference was observed between the IBR and AFR groups in the LRRFS (hazard ratio, 0.691; 95% CI, 0.433-1.102; P = 0.118), DFS (hazard ratio, 0.709; 95% CI, 0.468-1.076; P = 0.104), DMFS (hazard ratio, 1.006; 95% CI, 0.491-2.059; P = 0.987), or BCSS (hazard ratio, 0.445; 95% CI, 0.111-1.786; P = 0.659). In this propensity score-matched analysis of oncologic outcomes in patients with primary breast cancer who underwent immediate breast reconstruction with nipple-/skin-sparing mastectomy, no significant differences were observed between the IBR and AFR groups.
Highlights
With the tremendous improvement in breast cancer survivorship [1, 2], the quality of life (QoL) of patients has become an important aspect that requires consideration in the treatment strategy for breast cancer [3]
No significant differences were observed between the implant-based reconstruction (IBR) and autologous flap reconstruction (AFR) groups regarding the local recurrence (7.2% vs. 5.1%; P = 0.175), regional recurrence (2.1% vs. 1.5%; P = 0.463), or distant metastasis (3.2% vs. 3.2%; P = 1.000) rates
No significant difference was observed between the IBR and AFR groups in the Locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), or breast cancer-specific survival (BCSS)
Summary
With the tremendous improvement in breast cancer survivorship [1, 2], the quality of life (QoL) of patients has become an important aspect that requires consideration in the treatment strategy for breast cancer [3]. Breast reconstruction provides substantial body image and QoL benefits in patients receiving mastectomy [4, 5]. Previous studies have demonstrated that breast reconstruction using either implants or autologous tissue does not increase the risk of breast cancer recurrence compared to conventional mastectomy without reconstruction [8,9,10,11,12]. Few studies have compared breast cancer outcomes between the IBR and AFR [13]. Patients with breast cancer who had undergone or plan to undergo IBR should know about the relationship between breast implants and cancer recurrence or the differences in recurrence risk between IBR and AFR. A detailed evaluation of the oncologic significance of the different breast reconstruction methods can greatly help in the shared decision-making process between physicians and patients
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