Factors influencing the decision to offer immediate breast reconstruction after mastectomy for ductal carcinoma in situ (DCIS): the Institut Gustave Roussy Breast Cancer Study Group experience.
BACKGROUND
The increased rate of ductal carcinoma in situ (DCIS) is associated with a rise in indications for mastectomy and immediate breast reconstruction (IBR). The purpose of our study was to evaluate the factors affecting the indications for IBR and its modalities.


METHODS
Data concerning two hundred and thirty-eight consecutive patients with DCIS who had undergone modified radical mastectomy and a sentinel lymph node biopsy (SLNB) between 2005 and 2011 were extracted from our database. We then conducted a comparative study between patients who had undergone IBR and those who had not, to determine which factors affected the decision to offer IBR (LOE II).


RESULTS
About 57.1% had IBR and 42.9% had no reconstruction. The most common reason why IBR had not been performed was that it had not been proposed by the surgeon (33.4%). Of the 136 patients offered IBR, an implant had been proposed to the majority of them (81.6%). The IBR rate was highest among women under 50 years (52.2%), and was lower among women with diabetes (0.7%) or obesity (8.8%). The choice of reconstruction was not affected by tobacco use or positive SLNB results.


CONCLUSIONS
Factors predictive of the IBR reflect the influence of surgeon counselling and, to a lesser extent, consideration of patient comorbidities. However, there is a need to improve patient information and physician referral.
Department of Breast and Plastic Surgery, Institut Gustave Roussy, Villejuif, France.
Iptissem
I
Naoura
Chafika
C
Mazouni
Joseph
J
Ghanimeh
Nicolas
N
Leymarie
Jean-Rémi
JR
Garbay
Guillaume
G
Karsenti
Benjamin
B
Sarfati
Alexandre
A
Leduey
Frédéric
F
Kolb
Suzette
S
Delaloge
Françoise
F
Rimareix
D000367:Age Factors; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000150:complications / Q000601:surgery*; D003142:Communication; D003376:Counseling; D003657:Decision Making; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006801:Humans; D016462:Mammaplasty; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D013997:Time Factors
Breast cancer; Breast implant; Ductal carcinoma in situ; Immediate breast reconstruction; Mastectomy