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Bilateral Mastectomy versus Breast-Conserving Surgery for Early-Stage Breast Cancer: The Role of Breast Reconstruction

Albornoz, Claudia R. M.D., M.Sc.; Matros, Evan M.D., M.M.Sc.; Lee, Clara N. M.D., M.P.P.; Hudis, Clifford A. M.D.; Pusic, Andrea L. M.D., M.H.S.; Elkin, Elena Ph.D.; Bach, Peter B. M.D., M.A.P.P.; Cordeiro, Peter G. M.D.; Morrow, Monica M.D.

Plastic and Reconstructive Surgery: June 2015 - Volume 135 - Issue 6 - p 1518–1526
doi: 10.1097/PRS.0000000000001276
Breast: Original Articles

Background: Although breast-conserving surgery is oncologically safe for women with early-stage breast cancer, mastectomy rates are increasing. The objective of this study was to examine the role of breast reconstruction in the surgical management of unilateral early-stage breast cancer.

Methods: A retrospective cohort study of women diagnosed with unilateral early-stage breast cancer (1998 to 2011) identified in the National Cancer Data Base was conducted. Rates of breast-conserving surgery, unilateral and bilateral mastectomy with contralateral prophylactic procedures (per 1000 early-stage breast cancer cases) were measured in relation to breast reconstruction. The association between breast reconstruction and surgical treatment was evaluated using a multinomial logistic regression, controlling for patient and disease characteristics.

Results: A total of 1,856,702 patients were included. Mastectomy rates decreased from 459 to 360 per 1000 from 1998 to 2005 (p < 0.01), increasing to 403 per 1000 in 2011 (p < 0.01). The mastectomy rates rise after 2005 reflects a 14 percent annual increase in contralateral prophylactic mastectomies (p < 0.01), as unilateral mastectomy rates did not change significantly. Each percentage point of increase in reconstruction rates was associated with a 7 percent increase in the probability of contralateral prophylactic mastectomies, with the greatest variation explained by young age(32 percent), breast reconstruction (29 percent), and stage 0 (5 percent).

Conclusions: Since 2005, an increasing proportion of early-stage breast cancer patients have chosen mastectomy instead of breast-conserving surgery. This trend reflects a shift toward bilateral mastectomy with contralateral prophylactic procedures that may be facilitated by breast reconstruction availability.

New York, N.Y.; and Chapel Hill, N.C.

From the Plastic and Reconstructive Surgery Department, Breast Cancer Medicine Service, The Center for Health Policy and Outcomes, and the Breast Surgical Service, Memorial Sloan Kettering Cancer Center; and the Division of Plastic and Reconstructive Surgery, University of North Carolina.

Received for publication November 5, 2014; accepted December 15, 2014.

The first two authors contributed equally to this article.

Disclosure: The authors have no disclosures.

Evan Matros, M.D., M.M.Sc., Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Suite MRI 1036, New York, N.Y. 10065,

©2015American Society of Plastic Surgeons