Breast Cancer Recurrence after Implant-based Reconstruction: A Cohort Analysis of Time to Cancer Recurrence between Smooth versus Textured Devices

Abstract

BACKGROUND: A recent study demonstrated that reconstruction with textured breast implants is associated with breast cancer recurrence.1 Laboratory studies have implicated that local inflammation—secondary to postoperative complications—may contribute to cancer recurrence via cytokine and chemokine signaling.2 Implant surface texture may impact local inflammation in the breast, thereby impacting tumor regrowth and metastasis. We compared breast cancer recurrence rates in our own population of breast reconstruction patients with smooth versus textured devices. METHODS: Retrospective review of patients who underwent two-stage expander/implant reconstruction between 2006 and 2019 was performed. Demographics, cancer characteristics, device characteristics, postoperative complications, and local/distant cancer recurrences were collected. Kaplan-Meier analysis was performed for time to cancer recurrence. Unpaired t-test or Fisher exact test were performed to compare covariates between patients with and without recurrence. Binary logistic regression was performed for covariates that were significant on univariate testing. Patients with prophylactic mastectomy or stage IV cancer at the time of mastectomy were excluded. RESULTS: Of the 926 patients, 757 (81.7%) received textured versus 169 (18.2%) smooth devices. Average age was 49.4 years and average follow-up was 75.2 months. There was no difference in age, BMI, radiation, chemotherapy, ER-status, or cancer stage between textured and smooth expander patients. Local recurrence occurred in 11 (1.5%) textured device patients and no smooth device patients (P = 0.23). Distant recurrence occurred in 66 (8.7%) textured device patients and 10 (7.0%) smooth device patients (P = 0.54). There was no difference between patients with smooth and textured devices in time to local or distant recurrence (P = 0.32 and P = 0.09, respectively). Multivariate analysis associated ADM use with lower odds of distant recurrence (OR 0.46, P = 0.003). Kaplan-Meier analysis showed no difference in time to distant recurrence between all patients with and without ADM (P = 0.39). Sub-group analysis of Stage III cancers, however, showed a longer time to distant recurrence in patients reconstructed with ADM (P = 0.01). CONCLUSIONS: Growing concerns around the cancer-causing potential of textured devices exist. In this cohort study, there was no difference in cancer causing potential between smooth and textured devices. REFERENCES: 1. Lee K, Kim S, Jeon B, et al. Association of the implant surface texture used in reconstruction with breast cancer recurrence. JAMA Surg. 2020;155(12):1132–1140. doi:10.1001/jamasurg.2020.4124 2. Salvans S, Mayol X, Alonso S, et al. Postoperative peritoneal infection enhances migration and invasion capacities of tumor cells in vitro: an insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer. Ann Surg. 2014;260(5):939–943.