Continuing advances in breast reconstruction have provided surgeons with a multitude of reconstructive options. Concerns remain, however, about the effects of the various reconstructive methods on ultimate oncologic outcome. This study compares incidence, detection, and management of recurrent breast cancer in a large series of patients treated with mastectomy alone or with mastectomy and various forms of reconstruction.
A retrospective analysis was performed on all patients who underwent mastectomy and/or immediate reconstruction for breast cancer at our institution between January 1999 and December 2006. The 921 patients were divided into 2 groups: mastectomy and reconstruction (n = 494) and mastectomy alone (n = 427). All modern reconstructive methods were included. Patients were followed for a mean of 4.5 years.
The total incidence of recurrence—locoregional and/or distant—was 5.9% in patients who had mastectomy with reconstruction and 11.5% in patients who had mastectomy alone (P < 0.0023). The incidence of locoregional recurrence only was 2.2% in patients who had mastectomy with reconstruction and 4.0% in patients who had mastectomy alone (P = 0.1220). Of the 11 reconstructed patients with a locoregional recurrence, all recurrences were detected by self or clinical examination. Median time to detection was the same in both groups: 1.6 years (P = 0.5471).
Reconstruction with a variety of methods does not adversely affect the incidence or time to detection of recurrent breast cancer. Further, our data point to an important role for physical examination in tumor surveillance after mastectomy and reconstruction.
From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; †State University of New York–Upstate Medical University, Syracuse, NY; and ‡Department of Surgery, Harlem Hospital Center, Columbia University, New York, NY.
Received January 21, 2011, and accepted for publication February 9, 2011.
Supported by the Doris Duke Charitable Foundation (to J.H.Y.) and the Peter Jay Sharp Foundation (to S.C., M.S.C., A.M.T., and B.T.L.).
Presented at the Northeastern Society of Plastic Surgeons Meeting, October 31, Washington DC.
The authors have no financial interests in this research project or in any of the techniques or equipment used in this study. The authors have no conflicts of interest to disclose.
This study was approved by the Institution Review Board at the Beth Israel Deaconess Medical Center, Boston, MA.
Reprints: Bernard T. Lee, MD, FACS, Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St. Suite 5A, Boston, MA 02215. E-mail: firstname.lastname@example.org.