title: Immediate postmastectomy reconstruction is associated with improved breast cancer-specific survival: evidence and new challenges from the Surveillance, Epidemiology, and End Results database.
abstract: BACKGROUND
  Although immediate breast reconstruction is increasingly offered as part of postmastectomy psychosocial rehabilitation, concerns remain that it may delay adjuvant therapy or impair detection of local recurrence. No single population-based study has examined the relationship between immediate breast reconstruction and breast cancer-specific survival.
  
  
  METHODS
  By using data from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries, breast cancer-specific survival was compared for female unilateral mastectomy patients who did or did not undergo immediate breast reconstruction. Cox proportional hazards models were fitted, adjusting for known demographic and disease severity variables and stratifying on reconstruction type (implant or autologous) and age.
  
  
  RESULTS
  Improved breast cancer-specific survival was observed among all immediate breast reconstruction patients compared with patients who underwent mastectomy alone (hazard ratio [HR]=0.74; 95% confidence interval [CI], 0.68 to 0.80). Implant reconstruction patients below 50 years of age demonstrated the greatest apparent survival benefit (HR=0.47; 95% CI 0.28 to 0.80). Similarly, autologous reconstruction was associated with improved cancer-specific survival among patients below the age of 50 (HR=0.58; 95% CI, 0.42 to 0.80) and between ages 50 to 69 (HR=0.61; 95% CI, 0.43 to 0.85).
  
  
  CONCLUSIONS
  Immediate breast reconstruction is associated with decreased breast cancer-specific mortality, particularly among younger women. We believe this association is more likely attributable to imbalances in socioeconomic factors and access to care than to inadequate adjustment for tumor characteristics and disease severity. Further research is needed to identify additional prognostic factors responsible for the improved cancer survival among women undergoing immediate postmastectomy reconstruction.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. mbezuhly@dal.ca
authors.forename: Michael
authors.initials: M
authors.lastname: Bezuhly
authors.forename: Claire
authors.initials: C
authors.lastname: Temple
authors.forename: Leif J
authors.initials: LJ
authors.lastname: Sigurdson
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Gordon
authors.initials: G
authors.lastname: Flowerdew
authors.forename: E Francis
authors.initials: EF
authors.lastname: Cook
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000401:mortality*; D008408:Mastectomy / Q000401:mortality*; D008875:Middle Aged; D018426:SEER Program