title: Breast cancer recurrence following postmastectomy reconstruction compared to mastectomy with no reconstruction.
abstract: BACKGROUND
  Continuing advances in breast reconstruction have provided surgeons with a multitude of reconstructive options. Concerns remain, however, about the effects of the various reconstructive methods on ultimate oncologic outcome. This study compares incidence, detection, and management of recurrent breast cancer in a large series of patients treated with mastectomy alone or with mastectomy and various forms of reconstruction.
  
  
  METHODS
  A retrospective analysis was performed on all patients who underwent mastectomy and/or immediate reconstruction for breast cancer at our institution between January 1999 and December 2006. The 921 patients were divided into 2 groups: mastectomy and reconstruction (n = 494) and mastectomy alone (n = 427). All modern reconstructive methods were included. Patients were followed for a mean of 4.5 years.
  
  
  RESULTS
  The total incidence of recurrence-locoregional and/or distant-was 5.9% in patients who had mastectomy with reconstruction and 11.5% in patients who had mastectomy alone (P < 0.0023). The incidence of locoregional recurrence only was 2.2% in patients who had mastectomy with reconstruction and 4.0% in patients who had mastectomy alone (P = 0.1220). Of the 11 reconstructed patients with a locoregional recurrence, all recurrences were detected by self or clinical examination. Median time to detection was the same in both groups: 1.6 years (P = 0.5471).
  
  
  CONCLUSIONS
  Reconstruction with a variety of methods does not adversely affect the incidence or time to detection of recurrent breast cancer. Further, our data point to an important role for physical examination in tumor surveillance after mastectomy and reconstruction.
authors: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors: Sashank
authors: S
authors: Reddy
authors: Salih
authors: S
authors: Colakoglu
authors: Michael S
authors: MS
authors: Curtis
authors: Janet H
authors: JH
authors: Yueh
authors: Adeyemi
authors: A
authors: Ogunleye
authors: Adam M
authors: AM
authors: Tobias
authors: Bernard T
authors: BT
authors: Lee
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D011182:Postoperative Care / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors