title: Effect of implant vs. tissue reconstruction on cancer specific survival varies by axillary lymph node status in breast cancer patients.
abstract: BACKGROUND
  To compare the breast cancer-specific survival (BCSS) between patients who underwent tissue or implant reconstruction after mastectomy.
  
  
  METHODS
  We used the database from Surveillance, Epidemiology, and End Results (SEER) registries and compared the BCSS between patients who underwent tissue and implant reconstruction after mastectomy. Cox-regression models were fitted, adjusting for known clinicopathological features. The interaction between the reconstruction types (tissue/implant) and nodal status (N-stage) was investigated.
  
  
  RESULTS
  A total of 6,426 patients with a median age of 50 years were included. With a median follow up of 100 months, the 10-year cumulative BCSS and non-BCSS were 85.1% and 95.4%, respectively. Patients who underwent tissue reconstruction had tumors with a higher T-stage, N-stage, and tumor grade and tended to be ER/PR-negative compared to those who received implant reconstruction. In univariate analysis, implant-reconstruction was associated with a 2.4% increase (P = 0.003) in the BCSS compared with tissue-reconstruction. After adjusting for significant risk factors of the BCSS (suggested by univariate analysis) and stratifying based on the N-stage, there was only an association between the reconstruction type and the BCSS for the N2-3 patients (10-year BCSS of implant vs. tissue-reconstruction: 68.7% and 59.0%, P = 0.004). The 10-year BCSS rates of implant vs. tissue-reconstruction were 91.7% and 91.8% in N0 patients (P>0.05) and 84.5% and 84.4% in N1 patients (P>0.05), respectively.
  
  
  CONCLUSIONS
  The implant (vs. tissue) reconstruction after mastectomy was associated with an improved BCSS in N2-3 breast cancer patients but not in N0-1 patients. A well-designed, prospective study is needed to further confirm these findings.
authors.affiliation: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R.China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Ouyang
authors.affiliation: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R.China.
authors.forename: Liling
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R.China.
authors.forename: Kai
authors.initials: K
authors.lastname: Chen
authors.affiliation: Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R.China.
authors.forename: Fengxi
authors.initials: F
authors.lastname: Su
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000401:mortality*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D016462:Mammaplasty / Q000401:mortality*; D008408:Mastectomy; D008875:Middle Aged; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome