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Breast cancer outcomes following immediate breast reconstruction with implants versus autologous flaps: a propensity score-matched study

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Abstract

Purpose

A large proportion of patients with breast cancer who had mastectomy had undergone breast reconstruction with implants or autologous flaps. However, only a few studies have compared the breast cancer outcomes between the implant-based reconstruction (IBR) and autologous flap reconstruction (AFR). In this study, we retrospectively compared the local recurrence rates, distant metastasis rates, and survival outcomes between immediate IBR and AFR.

Methods

A total of 1530 patients with primary breast cancer who underwent IBR or AFR with nipple-/skin-sparing mastectomy were included. Patients who underwent neoadjuvant systemic therapy were excluded from the study. After propensity score matching by age at diagnosis, T stage, N stage, molecular subtype, mastectomy type, adjuvant radiotherapy status, and follow-up period, 938 patients were 1:1 matched, comprising the well-balanced IBR and AFR groups. Locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and breast cancer-specific survival (BCSS) were compared between the matched groups.

Results

After matching, the median follow-up periods were 68 months and 71 months for the IBR and AFR groups, respectively. No significant differences were observed between the IBR and AFR groups regarding the local recurrence (7.2% vs. 5.1%; P = 0.175), regional recurrence (2.1% vs. 1.5%; P = 0.463), or distant metastasis (3.2% vs. 3.2%; P = 1.000) rates. Moreover, no significant difference was observed between the IBR and AFR groups in the LRRFS (hazard ratio, 0.691; 95% CI, 0.433–1.102; P = 0.118), DFS (hazard ratio, 0.709; 95% CI, 0.468–1.076; P = 0.104), DMFS (hazard ratio, 1.006; 95% CI, 0.491–2.059; P = 0.987), or BCSS (hazard ratio, 0.445; 95% CI, 0.111–1.786; P = 0.659).

Conclusion

In this propensity score-matched analysis of oncologic outcomes in patients with primary breast cancer who underwent immediate breast reconstruction with nipple-/skin-sparing mastectomy, no significant differences were observed between the IBR and AFR groups.

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Funding

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Author information

Author notes

  1. Zhen-Yu Wu and Jing Han have contributed equally to this work.

Authors and Affiliations

  1. Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China

    Zhen-Yu Wu & Jing Han

  2. Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Zhen-Yu Wu, Hee Jeong Kim, Jong Won Lee, Il Yong Chung, Jisun Kim, Sae Byul Lee, Byung-Ho Son, Sei-Hyun Ahn & BeomSeok Ko

  3. Department of Plastic Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Hyun Ho Han & Jin Sup Eom

  4. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Jae Ho Jeong

  5. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Gyungyub Gong

  6. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Hak Hee Kim

Authors
  1. Zhen-Yu Wu
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  2. Jing Han
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  10. Jin Sup Eom
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  15. BeomSeok Ko
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Corresponding author

Correspondence to BeomSeok Ko.

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Conflict of interest

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Ethical approval

This study was approved by the institutional review board of Asan Medical Center, Seoul, Korea (No. 20201793). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Because of the retrospective nature of the study, the requirement for informed consent was waived, and the study was conducted with the exemption of consent under IRB deliberation as it used a platform that offers unidentified clinical information for research purposes.

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Wu, ZY., Han, J., Kim, H.J. et al. Breast cancer outcomes following immediate breast reconstruction with implants versus autologous flaps: a propensity score-matched study. Breast Cancer Res Treat 191, 365–373 (2022). https://doi.org/10.1007/s10549-021-06350-0

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  • DOI: https://doi.org/10.1007/s10549-021-06350-0

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