Breast Cancer Outcomes Following Immediate Breast Reconstruction with Implants Versus Autologous Flaps: A Propensity Score-Matched Study

Abstract

\n Purpose\n\nA large proportion of patients with breast cancer who had mastectomy had undergone breast reconstruction with implants or autologous flaps. However, only a few studies have compared the breast cancer outcomes between the implant-based reconstruction (IBR) and autologous flap reconstruction (AFR). In this study, we retrospectively compared the local recurrence rates, distant metastasis rates, and survival outcomes between immediate IBR and AFR.\nMethods\n\nA total of 1530 patients with primary breast cancer who underwent IBR or AFR with nipple-/skin-sparing mastectomy were included. Patients who underwent neoadjuvant systemic therapy were excluded from the study. After propensity score matching by age at diagnosis, T stage, N stage, molecular subtype, mastectomy type, adjuvant radiotherapy status, and follow-up period, 938 patients were 1:1 matched, comprising the well-balanced IBR and AFR groups. Locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and breast cancer-specific survival (BCSS) were compared between the matched groups.\nResults\n\nAfter matching, the median follow-up periods were 68 months and 71 months for the IBR and AFR groups, respectively. No significant differences were observed between the IBR and AFR groups regarding the local recurrence (7.2% vs. 5.1%; P\u2009=\u20090.175), regional recurrence (2.1% vs. 1.5%; P\u2009=\u20090.463), or distant metastasis (3.2% vs. 3.2%; P\u2009=\u20091.000) rates. Moreover, no significant difference was observed between the IBR and AFR groups in the LRRFS (hazard ratio, 0.691; 95% CI, 0.433–1.102; P\u2009=\u20090.118), DFS (hazard ratio, 0.709; 95% CI, 0.468–1.076; P\u2009=\u20090.104), DMFS (hazard ratio, 1.006; 95% CI, 0.491–2.059; P\u2009=\u20090.987), or BCSS (hazard ratio, 0.445; 95% CI, 0.111–1.786; P\u2009=\u20090.659).\nConclusion\n\nIn this propensity score-matched analysis of oncologic outcomes in patients with primary breast cancer who underwent immediate breast reconstruction with nipple-/skin-sparing mastectomy, no significant differences were observed between the IBR and AFR groups.