Does Breast Reconstruction After Mastectomy for Breast Cancer Affect Overall Survival? Long-term Follow-Up of a Retrospective Population-Based Cohort

Plast Reconstr Surg. 2015 Mar;135(3):468e-476e. doi: 10.1097/PRS.0000000000001054.

Abstract

Background: This study compared overall and breast cancer-specific survival using long-term follow-up data among women diagnosed with invasive breast cancer undergoing mastectomy or breast reconstruction.

Methods: Retrospective study using population-based data from Ontario Cancer Registry (1980 to 1990) including women receiving breast reconstruction within 5 years after mastectomy and controls of age- and cancer histology-matched women with mastectomy alone. We compared overall and breast cancer-specific survival using an extended Cox hazards model. Secondary analysis examined conditional survival across early, intermediate, and late follow-up.

Results: Seven hundred fifty-eight matched pairs formed the cohort, with a median follow-up of 23.4 years (interquartile range, 1.1 to 33.0 years). Fewer breast reconstruction patients died overall or from breast cancer compared with controls (overall survival, 44.5 percent versus 56.7 percent, p < 0.0001; breast cancer-specific survival, 31.8 percent versus 42.6 percent, p = 0.0002, respectively). Breast reconstruction was associated with a 17 percent reduced risk of death and a 19 percent reduced risk of breast cancer death, after adjustment (overall survival hazard ratio, 0.83; 95 percent CI, 0.72 to 0.96; breast cancer-specific survival hazard ratio, 0.81; 95 percent CI, 0.68 to 0.99). Among 885 women (58 percent) surviving 20 or more years, there was no difference in risk of death from breast cancer (hazard ratio, 0.59; 95 percent CI, 0.31 to 1.10).

Conclusion: In a large cohort with invasive breast cancer followed over 20 years, there is no evidence that breast reconstruction is associated with worse survival outcomes compared with mastectomy alone.

Clinical question/level of evidence: Therapeutic, III.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / mortality
  • Breast Neoplasms / surgery*
  • Cause of Death / trends
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Humans
  • Incidence
  • Mammaplasty / mortality*
  • Mastectomy*
  • Middle Aged
  • Ontario / epidemiology
  • Population Surveillance
  • Retrospective Studies
  • Time Factors
  • Young Adult