title: Timing of Postmastectomy Reconstruction Does Not Impair Breast Cancer-Specific Survival: A Population-Based Study.
abstract: BACKGROUND
  Debate remains over the optimal timing of breast reconstruction after mastectomy. Immediate reconstruction has demonstrated superior psychosocial and aesthetic outcomes, but might delay adjuvant therapy. Conversely, delayed reconstruction allows for timely initiation of adjuvant therapy, but with potentially inferior aesthetic results. The authors examined whether any significant breast cancer-specific survival difference exists on the basis of the timing of reconstruction after mastectomy.
  
  
  METHODS
  Using a cancer registry, medical insurance, and vital statistics sources, all Nova Scotia women who underwent unilateral mastectomy for breast cancer between 1989 and 2007 were followed to 2012 or time of death. Breast cancer-specific survival was compared for mastectomy patients who did or did not undergo reconstruction. Cox proportional hazards models were fitted adjusting for known demographic, disease severity variables, comorbidities, and reconstruction timing.
  
  
  RESULTS
  Of 6790 subjects included in the study, 331 (4.9%) underwent breast reconstruction. Of those who underwent reconstruction, 209 (63%) and 122 (37%) underwent immediate and delayed reconstruction, respectively. Univariate analysis showed improved breast cancer-specific survival among all breast reconstruction patients compared with patients who underwent mastectomy alone (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.48-0.86). In a multivariate model fitting a time-varying covariate to adjust for timing of reconstruction from mastectomy, no difference in survival was observed between patients who underwent reconstruction at any time and those who underwent mastectomy only (HR, 0.75; 95% CI, 0.56-1.00). No differences in breast cancer-specific survival were observed on the basis of type of reconstruction.
  
  
  CONCLUSIONS
  Results of the current study suggest that breast reconstruction, regardless of its timing, carries no increased risk of breast cancer-specific mortality compared with mastectomy alone.
authors.affiliation: Division of Plastic and Reconstructive Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada. Electronic address: mbezuhly@dal.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Bezuhly
authors.affiliation: Health Data Nova Scotia, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Division of Plastic and Reconstructive Surgery, Queen Elizabeth II Health Sciences Centre, Halifax Infirmary, Halifax, Nova Scotia, Canada.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Williams
authors.affiliation: Section of Plastic Surgery, Winnipeg Health Science Centre, Winnipeg, Manitoba, Canada.
authors.forename: Leif J
authors.initials: LJ
authors.lastname: Sigurdson
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D009674:Nova Scotia; D016016:Proportional Hazards Models; D013997:Time Factors
keywords: Breast reconstruction; Cox proportional hazards models; Delayed reconstruction; Disease-specific survival; Immediate reconstruction