title: Risk of recurrence following delayed large flap reconstruction after mastectomy for breast cancer.
abstract: BACKGROUND
  The aim of this retrospective matched cohort study was to evaluate the rate of recurrence among women with delayed large flap breast reconstruction after mastectomy for breast cancer. The recurrence rate among women treated at a single hospital was compared with that in an individually matched control group of women with breast cancer who did not have reconstruction after mastectomy.
  
  
  METHODS
  Between 1982 and 2001, 125 women with previous invasive breast carcinoma underwent delayed large flap breast reconstruction with pedicled musculocutaneous or microvascular flaps (a median of 32 months after mastectomy). They were matched individually with 182 women with breast cancer who had a mastectomy but did not undergo breast reconstruction. Matching criteria were year of diagnosis, age at diagnosis and treating hospital. Medical records were evaluated until October 2007. Histopathological specimens for all included women were re-evaluated. The endpoint was locoregional or distant breast cancer recurrence. The risk of recurrent disease was calculated using a Cox proportional hazards analysis, adjusted for established prognostic factors.
  
  
  RESULTS
  Median follow-up for the entire cohort was 146 months. The reconstruction group had a 2·08 (95 per cent confidence interval 1·07 to 4·06) times higher risk of recurrent disease than the mastectomy only group.
  
  
  CONCLUSIONS
  Women with breast cancer who had delayed reconstruction with a large flap in this study had a higher risk of recurrent disease than those with mastectomy alone.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Malmö, Sweden. anne.e.isern@ntnu.no
authors.forename: A E
authors.initials: AE
authors.lastname: Isern
authors.forename: J
authors.initials: J
authors.lastname: Manjer
authors.forename: J
authors.initials: J
authors.lastname: Malina
authors.forename: N
authors.initials: N
authors.lastname: Loman
authors.forename: T
authors.initials: T
authors.lastname: Mårtensson
authors.forename: A
authors.initials: A
authors.lastname: Bofin
authors.forename: A I
authors.initials: AI
authors.lastname: Hagen
authors.forename: I
authors.initials: I
authors.lastname: Tengrup
authors.forename: G
authors.initials: G
authors.lastname: Landberg
authors.forename: A
authors.initials: A
authors.lastname: Ringberg
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D016896:Treatment Outcome; D057832:Watchful Waiting