Bilateral Mastectomy versus Breast-Conserving Surgery for Early-Stage Breast Cancer: The Role of Breast Reconstruction. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Albornoz, Claudia R.; Matros, Evan; Lee, Clara N.; Hudis, Clifford A.; Pusic, Andrea L.; Elkin, Elena; Bach, Peter B.; Cordeiro, Peter G.; Morrow, Monica
• Is Part Of: Plastic and reconstructive surgery. Volume 135:Issue 6(2015:Jun.)
• Publication Date: 2015-06
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000001276
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : 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.