Oncological safety of autologous breast reconstruction after mastectomy for invasive breast cancer

Abstract

BackgroundThe number of patients requesting autologous breast reconstruction (ABR) after mastectomy for breast cancer has increased over the past decades. However, concern has been expressed about the oncological safety of ABR. The aim of our study was to assess the effect of ABR on distant relapse.MethodsIn this retrospective cohort study, data was analysed from patients who underwent mastectomy for invasive breast cancer in University Hospitals Leuven between 2000 and 2011. In total, 2326 consecutive patients were included, 485 who underwent mastectomy with ABR and 1841 who underwent mastectomy alone. The risk of relapse in both groups was calculated using a Cox proportional hazards analysis, adjusted for established prognostic factors. ABR was considered as a time-dependent variable. Additionally, the evolution of the risk over follow-up time was calculated.ResultsWith a median follow-up of 68 months, 8% of patients in the reconstruction group developed distant metastases compared to 15% in the mastectomy alone group (univariate HR 0.70, 95% CI 0.50–0.97, p = 0.0323). However, after adjustment for potential confounding factors in a Cox multivariable analysis, the risk of distant relapse was no longer significantly different between groups (multivariate HR 0.82, 95% CI 0.55–1.22, p = 0.3301). Moreover, the risk of metastasis after reconstruction was not time-dependent.ConclusionsThese findings suggest that there is no effect of ABR on distant relapse rate and thus that ABR is an oncological safe procedure. The rate of local recurrence was too low to make any significant conclusions.

Breast Cancer Outcomes Following Immediate Breast Reconstruction with Implants Versus Autologous Flaps: A Propensity Score-Matched Study

“…However, to date, no randomized controlled data on the differences in the oncologic safety between mastectomy with breast reconstruction and without breast reconstruction or the oncologic outcomes of different reconstruction methods is available due to ethical concerns. Most existing studies based on retrospective data have documented that both IBR and AFR did not increase the risk of breast cancer recurrence [8][9][10][11][12]. However, con icting results have indicated that postmastectomy AFR has an increased risk of cancer recurrence compared with mastectomy alone [25].…”

“…Meanwhile, postmastectomy reconstruction options mainly include implant-based reconstruction (IBR) and autologous ap reconstruction (AFR) in the current clinical practice. 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]. However, few studies have compared breast cancer outcomes between the IBR and AFR [13].…”

Development of an invasive ductal carcinoma in a contralateral composite nipple graft after an autologous breast reconstruction: a case report

“…Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Japan. 3 Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan. 4 Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.…”

“…It is an integral part of the breast reconstruction process, as patients associate this stage with the end of their plastic surgery treatment and a sense of completion [ 2 ]. It was once a concern that surgical trauma could activate dormant micrometastases; however, more recent reports have shown no increased risk of breast cancer recurrence following breast reconstruction [ 3 ]. New primary carcinomas arising from the grafted breast tissue have rarely been reported following surgery for breast cancer.…”

The difference in local, regional and distant breast cancer recurrence between the immediate and delayed DIEP flap procedure; a retrospective cohort study

“…The extensive and prolonged autologous breast reconstructive surgery may be considered a major tissue trauma suggesting autologous breast reconstruction increases the breast cancer recurrence risk. However, studies have shown different results [12][13][14][15], probably owing to inclusion of heterogenous breast reconstructive surgery and lack of homogeneous study populations.…”