Timing of Postmastectomy Reconstruction Does Not Impair Breast Cancer-Specific Survival: A Population-Based Study

Using a provincial cancer registry, medical insurance, and vital statistics data, we compared breast cancer-specific survival between mastectomy patients who did or did not undergo reconstruction using Cox proportional hazards models. We demonstrate that timing of postmastectomy reconstruction does not negatively affect breast cancer-specific survival. Our findings support the oncologic safety of breast reconstruction, regardless of whether it is performed immediately at the time of mastectomy or in a delayed fashion. Background: Debate remains over the optimal timing of breast reconstruction after mastectomy. Immediate reconstruction has demonstrated superior psychosocial and aesthetic outcomes, but might delay adjuvant therapy. Conversely, delayed reconstruction allows for timely initiation of adjuvant therapy, but with potentially inferior aesthetic results. The authors examined whether any significant breast cancer-specific survival difference exists on the basis of the timing of reconstruction after mastectomy. Patients and Methods: Using a cancer registry, medical insurance, and vital statistics sources, all Nova Scotia women who underwent unilateral mastectomy for breast cancer between 1989 and 2007 were followed to 2012 or time of death. Breast cancer-specific survival was compared for mastectomy patients who did or did not undergo reconstruction. Cox proportional hazards models were fitted adjusting for known demographic, disease severity variables, comorbidities, and reconstruction timing. Results: Of 6790 subjects included in the study, 331 (4.9%) underwent breast reconstruction. Of those who underwent reconstruction, 209 (63%) and 122 (37%) underwent immediate and delayed reconstruction, respectively. Univariate analysis showed improved breast cancer-specific survival among all breast reconstruction patients compared with patients who underwent mastectomy alone (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.48-0.86). In a multivariate model fitting a time-varying covariate to adjust for timing of reconstruction from mastectomy, no difference in survival was observed between patients who underwent reconstruction at any time and those who underwent mastectomy only (HR, 0.75; 95% CI, 0.56-1.00). No differences in breast cancer-specific survival were observed on the basis of type of reconstruction. Conclusion: Results of the current study suggest that breast reconstruction, regardless of its timing, carries no increased risk of breast cancer-specific mortality compared with mastectomy alone. (C) 2015 Elsevier Inc. All rights reserved.