Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan 30;20(1):78.
doi: 10.1186/s12885-020-6568-2.

Oncologic outcomes after immediate breast reconstruction following mastectomy: comparison of implant and flap using propensity score matching

Jeong Hyun Ha  1 , Ki Yong Hong  2 , Han-Byoel Lee  3 , Hyeong-Gon Moon  4 , Wonshik Han  3   4 , Dong-Young Noh  3   4 , Joonho Lim  1 , Sehoon Yoon  1 , Hak Chang  1   5 , Ung Sik Jin  6   7
Affiliations

Oncologic outcomes after immediate breast reconstruction following mastectomy: comparison of implant and flap using propensity score matching

Jeong Hyun Ha et al. BMC Cancer. .

Abstract

Background: Although immediate breast reconstruction has been reported to be oncologically safe, no affirmative study comparing the two reconstruction methods exists. We investigated breast cancer recurrence rates in two breast reconstruction types; implant reconstruction and autologous flap reconstruction.

Methods: A retrospective cohort study was performed on propensity score-matched (for age, stage, estrogen receptor status) patients who underwent IBR after mastectomy at Seoul National University Hospital between 2010 and 2014. The main outcomes determined were locoregional recurrence-free interval (LRRFI) and disease-free interval (DFI).

Results: We analyzed 496 patients among 731 patients following propensity score matching (Median age 43, 247 implant reconstruction and 249 flap reconstruction). During median follow-up of 58.2 months, DFI was not different between the two groups at each tumor stage. However, flap reconstruction showed inferior DFI compared to implant reconstruction in patients with high histologic grade (p = 0.012), and with high Ki-67 (p = 0.028). Flap reconstruction was related to short DFI in multivariate analysis in aggressive tumor subsets. Short DFI after flap reconstruction in aggressive tumor cell phenotype was most evident in hormone positive/Her-2 negative cancer (p = 0.008). LRRFI, on the other hand, did not show difference according to reconstruction method regardless of tumor cell aggressiveness.

Conclusion: Although there is no difference in cancer recurrence according to reconstruction method in general, flap-based reconstruction showed higher systemic recurrence associated with histologically aggressive tumors.

Keywords: Breast neoplasm; Breast reconstruction; Flap; Implant; Oncologic safety.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Disease free survival (a) and Locoregional relapse free interval (b) in implant and flap based immediate breast reconstruction
Fig. 2
Fig. 2
Disease free survival in (a) Stage I, (b) Stage II, and (c) Stage III patients according to breast reconstruction type
Fig. 3
Fig. 3
Disease free interval (DFI) in (a) Histologic grade 1–2, (b) Histologic grade 3, (c) Ki-67 < 10%, (d) Ki-67 ≥ 10% patients according to breast reconstruction type. DFI of aggressive tumor (high histologic grade and high Ki-67) in (e) hormone positive, (f) hormone positive/Her2-negative patients according to breast reconstruction type
See this image and copyright information in PMC

References

    1. Panchal H, Matros E. Current trends in Postmastectomy breast reconstruction. Plast Reconstr Surg. 2017;140:7S–13S. doi: 10.1097/PRS.0000000000003941. - DOI - PMC - PubMed
    1. Xavier Harmeling J, et al. The effect of immediate breast reconstruction on the timing of adjuvant chemotherapy: a systematic review. Breast Cancer Res Treat. 2015;153:241–251. doi: 10.1007/s10549-015-3539-4. - DOI - PMC - PubMed
    1. Howard MA, et al. Breast cancer local recurrence after mastectomy and TRAM flap reconstruction: incidence and treatment options. Plast Reconstr Surg. 2006;117:1381–1386. doi: 10.1097/01.prs.0000208116.86765.4a. - DOI - PubMed
    1. Patani N, Devalia H, Anderson A, Mokbel K. Oncological safety and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction. Surg Oncol. 2008;17:97–105. doi: 10.1016/j.suronc.2007.11.004. - DOI - PubMed
    1. McCarthy CM, et al. Breast cancer recurrence following prosthetic, postmastectomy reconstruction: incidence, detection, and treatment. Plast Reconstr Surg. 2008;121:381–388. doi: 10.1097/01.prs.0000298316.74743.dd. - DOI - PubMed