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Study: No evidence to support link between poor outcomes, breast reconstruction vs. mastectomy

After evaluating a large cohort of patients with invasive breast cancer with more than 20 years of follow-up, researchers found no evidence that breast reconstruction was associated with worse survival outcomes compared with mastectomy alone.

The retrospective study utilized population-based data from the Ontario Cancer Registry for women who underwent breast reconstruction within 5 years after mastectomy between the years of 1980 and 1990. The researchers compared findings with those of controls matched for age and cancer histology who underwent mastectomy alone.

The final cohort comprised 758 matched pairs of women between the ages of 20 and 65 years with no previous cancer diagnosis who underwent mastectomy within 3 months of diagnosis. Median follow-up was 23.4 years.

Breast reconstruction patients had a median time to reconstruction surgery of 1.5 years, and median age at diagnosis was 45 years for patients in both the reconstruction and control cohorts. Tumor size distribution was observed to be similar between the two groups, but lymph node status differed between groups, according to the researchers. Forty-four percent of patients in the breast reconstruction cohort had N₀ nodal disease compared with 36.4% of controls.

The researchers identified 345 deaths overall among breast reconstruction patients compared with 430 deaths among controls. Of those, 241 and 323 deaths, respectively, were breast cancer-specific among breast reconstruction patients and controls.

Overall survival estimates at 25 years postoperatively were 57.5% for breast reconstruction and 47.5% for controls using the Kaplan-Meier plots. Breast cancer-specific survival estimates were 67.5% for breast reconstruction patients and 57.5% for controls.

Compared with patients in the control group, those who underwent breast reconstruction were 17% less likely to die and 19% less likely to die from a cause related to breast cancer, according to the researchers.

The researchers determined large tumors, positive or missing lymph nodes and surgery in a hospital with greater mastectomy values were among the factors associated with worse overall or breast cancer-specific survival.

During the first 10 years of follow-up, the researchers found no difference in risk of death from breast cancer between the groups. Among patients who survived for at least 10 years after surgery, patients who underwent breast reconstruction had a substantially lower risk of death from breast cancer during the subsequent 10 years’ follow-up compared with controls. However, the researchers found no significant difference in risk of death from breast cancer among long-term breast cancer survivors during the last 10 years of follow-up. – by Abigail Sutton

Disclosure: The researchers report no relevant financial disclosures.