Breast Reconstruction Immediately After Mastectomy Linked to Increased Survival

Fran Lowry

October 06, 2010

October 6, 2010 (Toronto, Canada) — Reconstruction of the breast immediately after mastectomy is associated with significantly improved breast-cancer-specific survival, according to research presented here at Plastic Surgery 2010: Joint Annual Scientific Meeting of the American Society of Plastic Surgery (ASPS) and the Canadian Society of Aesthetic Plastic Surgery (CSAPS).

The finding comes from an analysis of the US National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registry database, which looked at cases of breast cancer between 1998 and 2003. It was reported by Michael Bezuhly, MD, from Dalhousie University College of Medicine in Halifax, Nova Scotia.

"The benefits of immediate breast reconstruction are well documented now, and include reduced depression and improved well-being," Dr. Bezuhly said. "Although it is increasingly being offered as part of postmastectomy psychosocial rehabilitation, concerns remain that it may delay adjuvant therapy or impair detection of local recurrence."

However, he continued, "no study has examined the relationship between immediate breast reconstruction and breast-cancer-specific survival."

The SEER analysis consisted of more than 46,000 women who had undergone mastectomy alone and 8500 who had undergone a first course of reconstruction at the time of mastectomy. The reconstruction group was further divided into autologous or implant reconstruction groups.

The analysis showed that immediate breast reconstruction was associated with a 26% reduction in breast-cancer-specific mortality, Dr. Bezuhly said.

Improved breast-cancer-specific survival was observed in all immediate breast reconstruction patients, compared with those who underwent mastectomy alone (hazard ratio, 0.74; 95% confidence interval, 0.68 - 0.80). This was true, regardless of the age of the patient, he noted.

"With the implant-only group, this relationship was seen only in patients less than 50 years of age. In the autologous only group, it was seen in patients less than 70," Dr. Bezuhly said.

Asked by Medscape Medical News if immediate breast reconstruction was, in fact, saving lives, Dr. Bezuhly said: "I don't think we're producing better breast cancer survival with immediate breast reconstruction, no. Our hypothesis is that reconstruction may be a surrogate for breast cancer patients who are destined to do well based on their socioeconomic status. We couldn't address this aspect through the SEER database."

There is a large body of literature suggesting that patients who undergo immediate reconstruction are usually in higher income brackets and are better educated and, therefore, more likely to go on to reconstruction.

As well, patients with better access to good cancer centers are more likely to be referred to reconstructive surgery by their general surgeons.

"This is the first study to use a large population base to define the oncologic safety of immediate reconstruction, specifically autologous reconstruction, but clearly the SEER database has many inadequacies," he said.

To overcome these shortcomings, Dr. Bezuhly and colleagues are planning to look at Canadian data to see if this association between improved breast cancer survival and reconstruction bears out in a universal healthcare system.

Commenting on this study for Medscape Medical News, Karol Gutowski, MD, from the University of Chicago, in Illinois, said: "I don't think that any of us believe that if I reconstruct your breast I may have extended your life or saved your life. It may be that such reconstruction means that you are more likely to be in a place that provides better treatment."

He added that the study is interesting and "begs for more research. I'd be wary about drawing any conclusions. This does not mean that reconstruction improves survival, it just means that we need to explore why this is going on, because it could be explained by something that is completely unrelated."

Scott Spear, MD, chair of plastic surgery at Georgetown University, in Washington, DC, agreed. "It's probably related to the socioeconomic status of the patients to begin with — that they are more informed people who take better care of themselves. They probably have better survival overall anyway. But it's still good to know that if you have a good breast reconstruction, it certainly doesn't make your survival worse, and it might help."

He added: "I think there's also a psychological component. They're more motivated people and it's been shown by other studies that people who are more optimistic actually do better with their cancers than people who are not optimistic."

Dr. Bezuhly, Dr. Gutowski, and Dr. Spear have disclosed no relevant financial relationships.

Plastic Surgery 2010: Joint Annual Scientific Meeting of the American Society of Plastic Surgery (ASPS) and the Canadian Society of Aesthetic Plastic Surgery (CSAPS). Presented October 3, 2010.


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