Patterns of reconstruction after unilateral and bilateral mastectomies.

Abstract

143 Background: A trend for the increased usage of mastectomy to treat breast cancer and for prophylaxis has been reported. Postmastectomy reconstruction (PMR) may improve body image and quality of life for breast cancer survivors. This prompted an investigation of the current pattern of PMR in our breast surgery practice. Methods: An IRB-approved retrospective chart review of women who had mastectomies performed by dedicated breast surgeons from 2006 through 2009 was completed. Data collected included age, unilateral (ULM) or bilateral mastectomy (BLM), type and timing of reconstruction, BRCA status, presence of an in-breast tumor recurrence (IBTR). Two-sided Fisher exact test and t-test were used in comparing groups. Results: From 2006 to 2009, 231 patients ranging in age from 27 to 91 years had ULM (n=155) or BLM (n=76). 38% of the patients had PMR. Patients <50 years old were more likely to undergo PMR than those >50 (67.5% versus 22.7%, p< 0.0001). 4 patients >70 years old had PMR. PMR followed ULM 27.7% of the time and BM 57.9% (p < 0.0001). Only 6 patients underwent delayed PMR. 30 patients had mastectomies after IBTR with 36.7% having PMR and 36.7% opting for BLM. These rates were not significantly different from women with a unilateral de novo breast cancer (33.1% and 21.3%, respectively). In 15 patients with a BRCA mutation, one had ULM. The 14 having BLM were more likely to have BMR than BLM patients without a mutation (92.9% versus 50.0%, respectively, p=0.0029) and were younger (44.6 versus 52.3 years, respectively, p=0.0166). Types of reconstructions were divided between tissue expander/implant (TE/I)(70%) and autologous tissue flaps (AT) techniques. After BLM, TE/I was employed more frequently than after UM (84% versus 56%, respectively, p=0.005). From 2006 to 2009, there was no significant change in type or frequency of PMR. Conclusions: From this data it appears that a majority of women do not have PMR and few women return for a delayed PMR. Fewer women seek PMR after ULM. Rates and types of PMR have not changed over this time period. Further investigation to determine if women feel informed about PRM and to identify factors influencing their choices may be helpful in improving a PMR program.