June 29, 2010

Agarwal S, Liu JH, Crisera CA, Buys S, Agarwal JP.
Pritzker School of Medicine, University of Chicago

Immediate and early-delayed breast reconstruction are the preferred methods of reconstruction in breast cancer patients treated with mastectomy. These options for reconstruction allow for superior outcomes through peri-operative planning between the oncologic surgeon and reconstructive team. We used the Surveillance Epidemiology, and End Results (SEER) database to study the overall survival of patients treated with immediate or early-delayed breast reconstruction after mastectomy. Population level de-identified data was abstracted from the National Cancer Institute’s SEER cancer database. We obtained data from all female patients with breast cancer treated with mastectomy from 2000 to 2002. Patients with missing or incomplete data were excluded. Univariate and multivariate statistics were performed using Intercooled Stata 7.0 (College Station, TX). A total of 51,702 patients were included in the study. The mean age was 60.8 (range 20-104) years old. Reconstruction was performed in 16.7% of patients. Multivariate analysis showed that patients treated with mastectomy and reconstruction had a significantly lower hazard ratio of death (HR=0.62, p<0.001) compared with patients treated with mastectomy only, when controlling for demographic and oncologic covariates. Black patients comprised 7.5% of the total population, and multivariate analysis showed that black patients had a significantly increased hazard ration of death (HR=1.43, p<0.001) when compared with white patients, when controlling for all other covariates including reconstructive status. We show that women with breast cancer who undergo breast reconstruction after mastectomy do not have a worse overall survival than those not undergoing breast reconstruction. This is true when patient age, race, income, and marital status; and tumor stage, histology, grade, use of radiotherapy, and mastectomy site (bilateral or unilateral) are controlled for.


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