National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy

Abstract

Background Immediate breast reconstruction (IBR) is often deferred, when postmastectomy radiotherapy (PMRT) is anticipated, due to high complication rates. Nonetheless, because of robust data supporting improved health-related quality of life associated with reconstruction, physicians and patients may be more accepting of tradeoffs. The current study explores national trends of IBR utilization rates and methods in the setting of PMRT, using the National Cancer Database (NCDB). The study hypothesis is that prosthetic techniques have become the most common method of IBR in the setting of PMRT. Methods NCDB was queried from 2004 to 2013 for women, who underwent mastectomy with or without IBR. Patients were grouped according to PMRT status. Multivariate logistic regression was used to calculate odds of IBR in the setting of PMRT. Trend analyses were done for rates and methods of IBR using Poisson regression to determine incidence rate ratios (IRRs). Results In multivariate analysis, radiated patients were 30% less likely to receive IBR (p < 0.05). The rate increase in IBR was greater in radiated compared with nonradiated patients (IRR: 1.12 vs. 1.09). Rates of reconstruction increased more so in radiated compared with nonradiated patients for both implants (IRR 1.15 vs. 1.11) and autologous techniques (IRR 1.08 vs. 1.06). Autologous reconstructions were more common in those receiving PMRT until 2005 (p < 0.05), with no predominant technique thereafter. Conclusion Although IBR remains a relative contraindication, rates of IBR are increasing to a greater extent in patients receiving PMRT. Implants have surpassed autologous techniques as the most commonly used method of breast reconstruction in this setting.

Figure 1. Rate of implant based breast reconstructions from 2004 – 2013^a

^a Does not include combined and ‘not otherwise specified’ codes of breast reconstruction. * p value is significant (<0.05); Rate: Number of reconstruction per 1000 mastectomies IRR: Incident Rate Ratio, PMRT: Post-Mastectomy Radiation Therapy

Figure 2. Rate of Autologous Breast Reconstructions from 2004 – 2013^b

^b Does not include combined and ‘not otherwise specified’ codes of breast reconstruction. * p value is significant (<0.05); Rate: Number of reconstruction per 1000 mastectomies, IRR: Incident Rate Ratio, PMRT: Post-Mastectomy Radiation Therapy