Abstract
Background
Rates of breast reconstruction in males with breast cancer have yet to be defined. Despite extensive literature on breast reconstruction in females, a paucity of studies exists for male patients. The aim of this study is to assess the incidence and trends in breast reconstruction in males with breast cancer using the National Surgical Quality Improvement Project (NSQIP) database.
Methods
The 2005 to 2016 NSQIP database was queried to identify males with breast cancer who underwent partial or total mastectomy. Males who underwent post-mastectomy reconstruction were compared to those who did not. Primary outcomes included postoperative complications and mortality.
Results
A total of 1,167 males underwent breast surgery, of which 73 (6.3%) underwent reconstruction within 30 days. The majority of patients receiving reconstruction were Caucasian (74.0%) followed by African-American (11.0%), and Asian (5.5%). Asian males had the highest rate of post-mastectomy reconstruction (n = 4, 13.8%). Males who underwent reconstruction had higher rates of postoperative wound dehiscence compared to those who did not undergo reconstruction (2.7% vs. 0%, p = 0.004). The most common reconstructive procedure was implant-based reconstruction (n = 37, 50.7%). African-American males tended to have less implant-based reconstruction than Caucasian (p = 0.057) and Asian males (p = 0.019). African- American males tended to have more free flap reconstruction than Caucasian males (p = 0.034).
Conclusions
Post-mastectomy reconstruction is rarely performed in males with breast cancer. Most males undergo implant-based reconstruction, although racial differences exist. Further studies are warranted to assess long-term reconstruction and psychosocial outcomes in males who undergo breast reconstruction.
Level of evidence: Level III, Diagnostic study.
Similar content being viewed by others
Data Availability
The authors confirm that the data supporting the findings of this study are available within the 2005-2016 NSQIP databases.
References
Burga AM, Fadare O, Lininger RA, Tavassoli FA (2006) Invasive carcinomas of the male breast: a morphologic study of the distribution of histologic subtypes and metastatic patterns in 778 cases. Virchows Arch 449(5):507–512. https://doi.org/10.1007/s00428-006-0305-3
Banys-Paluchowski M, Burandt E, Banys J et al. (2016) Male papillary breast cancer treated by wide resection and latissimus dorsi flap reconstruction: A case report and review of the literature. World J Clin Oncol 7(5):420–424. https://doi.org/10.5306/wjco.v7.i5.420
White J, Kearins O, Dodwell D, Horgan K, Hanby AM, Speirs V (2011) Male breast carcinoma: increased awareness needed. Breast Cancer Res 13(5):219. https://doi.org/10.1186/bcr2930
Czajka ML, Pfeifer C (2023) Breast cancer surgery. In: Statpearls [Internet]. Treasure Island (FL): Statpearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553076/
Cuccolo NG, Kang CO, Boskey ER, et al. (2019) Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes. Plast Reconstruct Surg – Global Open 7(6):e2316. https://doi.org/10.1097/gox.0000000000002316
Deldar R, Sayyed AA, Towfighi P et al. (2022) Postmastectomy Reconstruction in Male Breast Cancer. Breast J 2022:5482261. https://doi.org/10.1155/2022/5482261
Danino A, Ichinose M, Yoshimoto S, Kuroki T, Servant JM (1998) External-internal oblique reverse blood supply musculocutaneous flap for chest wall reconstruction. Ann Plast Surg 41(4):430–433. https://doi.org/10.1097/00000637-199810000-00015
Di Benedetto G, Pierangeli M, Bertani A (1998) Carcinoma of the male breast: an underestimated killer. Plast Reconstr Surg 102(3):696–700. https://doi.org/10.1097/00006534-199809030-00012
Igun GO (2000) Rectus abdominis myocutaneous flap in reconstruction for advanced male breast cancer: case report. Cent Afr J Med 46(5):130–132
Elshafiey MM, Zeeneldin AA, Elsebai HI et al (2011) Epidemiology and management of breast carcinoma in Egyptian males: experience of a single Cancer Institute. J Egypt Natl Canc Inst 23(3):115–122. https://doi.org/10.1016/j.jnci.2011.10.001
Nakao A, Saito S, Naomoto Y, Matsuoka J, Tanaka N (2002) Deltopectoral flap for reconstruction of male breast after radical mastectomy for cancer in a patient on hemodialysis. Anticancer Res 22(4):2477–2479
Spear SL, Bowen DG (1998) Breast reconstruction in a male with a transverse rectus abdominis flap. Plast Reconstr Surg 102(5):1615–1617. https://doi.org/10.1097/00006534-199810000-00043
Schaverien MV, Scott JR, Doughty JC (2013) Male mastectomy: an oncoplastic solution to improve aesthetic appearance. J Plast Reconstr Aesthet Surg 66(12):1777–1779. https://doi.org/10.1016/j.bjps.2013.04.039
Al-Kalla T, Komorowska-Timek E (2014) Breast total male breast reconstruction with fat grafting. Plast Reconstr Surg Glob Open 2(11):e257. https://doi.org/10.1097/gox.0000000000000221
Bamba R, Krishnan NM, Youn R, Economides JM, Pittman TA (2018) The Use of Low-Profile Silicone Breast Implants in Male Breast Reconstruction. Plast Reconstr Surg 141(2):324e–325e. https://doi.org/10.1097/prs.0000000000004089
Kinne DW (1991) Management of male breast cancer. Oncology (Williston Park). 5(3):45–7 (discussion 47-8)
Giordano SH, Buzdar AU, Hortobagyi GN (2002) Breast cancer in men. Ann Intern Med 137(8):678–687. https://doi.org/10.7326/0003-4819-137-8-200210150-00013
Robinson JD, Metoyer KP Jr, Bhayani N (2008) Breast cancer in men: a need for psychological intervention. J Clin Psychol Med Settings 15(2):134–139. https://doi.org/10.1007/s10880-008-9106-y
Qin Q, Tan Q, Lian B, Mo Q, Huang Z, Wei C (2018) Postoperative outcomes of breast reconstruction after mastectomy: A retrospective study. Medicine (Baltimore). 97(5):e9766. https://doi.org/10.1097/md.0000000000009766
Rubino C, Figus A, Lorettu L, Sechi G (2007) Post-mastectomy reconstruction: a comparative analysis on psychosocial and psychopathological outcomes. J Plast Reconstr Aesthet Surg 60(5):509–518. https://doi.org/10.1016/j.bjps.2006.06.013
Heneghan HM, Prichard RS, Lyons R et al (2011) Quality of life after immediate breast reconstruction and skin-sparing mastectomy - a comparison with patients undergoing breast conserving surgery. Eur J Surg Oncol 37(11):937–943. https://doi.org/10.1016/j.ejso.2011.08.126
Giunta G, Rossi M, Toia F, Rinaldi G, Cordova A (2017) Male breast cancer: Modified radical mastectomy or breast conservation surgery? A case report and review of the literature. Int J Surg Case Rep 30:89–92. https://doi.org/10.1016/j.ijscr.2016.11.030
Friedman S, Floyd C, Chrysopoulo M. Men can have breast reconstruction after mastectomy. Facing Our Risk of Cancer Empowered, Inc. Accessed February 17, 2022. https://www.facingourrisk.org/blog/men-can-have-breast-reconstruction-after-mastectomy
Eck DL, Koonce SL, Goldberg RF et al (2012) Breast surgery outcomes as quality measures according to the NSQIP database. Ann Surg Oncol 19(10):3212–3217. https://doi.org/10.1245/s10434-012-2529-6
American Medical Association (2007) Surgery: Integumentary system. CPT Assistant Newsletter 17(12):7
American Medical Association (2015) Coding brief: Coding for breast surgery. CPT Assistant Newsletter 25(3):5–11
Platt J, Baxter N, Zhong T (2011) Breast reconstruction after mastectomy for breast cancer. CMAJ 183(18):2109–2116. https://doi.org/10.1503/cmaj.110513
Co M, Lee A, Kwong A (2020) Delayed presentation, diagnosis, and psychosocial aspects of male breast cancer. Cancer Med 9(10):3305–3309. https://doi.org/10.1002/cam4.2953
Brain K, Williams B, Iredale R, France L, Gray J (2006) Psychological distress in men with breast cancer. J Clin Oncol 24(1):95–101. https://doi.org/10.1200/jco.2006.10.064
Wolters U, Wolf T, Stützer H, Schröder T (1996) ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 77(2):217–222. https://doi.org/10.1093/bja/77.2.217
Hackett NJ, De Oliveira GS, Jain UK, Kim JY (2015) ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg 18:184–190. https://doi.org/10.1016/j.ijsu.2015.04.079
Angarita FA, Acuna SA, Cordeiro E et al (2018) Thirty-day postoperative morbidity and mortality in elderly women with breast cancer: an analysis of the NSQIP database. Breast Cancer Res Treat 170:373+
de Blacam C, Ogunleye AA, Momoh AO et al (2012) High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,988 patients from the national surgical quality improvement program database. Ann Surg 255(3):551–555. https://doi.org/10.1097/SLA.0b013e318246c294
El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W (2007) Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg 245(5):665–671. https://doi.org/10.1097/01.sla.0000245833.48399.9a
Epstein S, Tran BN, Cohen JB, Lin SJ, Singhal D, Lee BT (2018) Racial disparities in postmastectomy breast reconstruction: National trends in utilization from 2005 to 2014. Cancer 124(13):2774–2784. https://doi.org/10.1002/cncr.31395
Panchal H, Matros E (2017) Current Trends in Postmastectomy Breast Reconstruction. Plast Reconstr Surg. 140(5S Advances in Breast Reconstruction):7s–13s. https://doi.org/10.1097/prs.0000000000003941
Alluri RK, Leland H, Heckmann N (2016) Surgical research using national databases. Ann Transl Med 4(20):393. https://doi.org/10.21037/atm.2016.10.49
Yoon AP, Qi J, Brown DL et al (2018) Outcomes of immediate versus delayed breast reconstruction: Results of a multicenter prospective study. Breast 37:72–79. https://doi.org/10.1016/j.breast.2017.10.009
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
This study utilized a national database using human subject data, for which our institution received IRB, ethical approval, and informed consent prior to conducting this study.
Conflict of interest and financial disclosure statement
There are no financial disclosures, commercial associations, or any other conditions posing a conflict of interest to report for any of the above authors.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Towfighi, P., Haffner, Z.K., Sayyed, A.A. et al. Breast Reconstruction in Male Breast Cancer Patients: An analysis of trends using the NSQIP database. Eur J Plast Surg 46, 1113–1119 (2023). https://doi.org/10.1007/s00238-023-02091-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-023-02091-z