title: Trends in mastectomy and reconstruction for breast cancer; a twelve year experience from a tertiary care center.
abstract: BACKGROUND
  Many surgical options exist for breast cancer, including breast conserving therapy (BCT), mastectomy with reconstruction (MAST+RECON) or without reconstruction (MAST). Long-term results regarding oncologic outcomes are few and primarily retrospective studies.
  
  
  METHODS
  A retrospective review of a prospectively collected database of patients undergoing breast surgery for breast cancer from 2002 to 2014 was performed. Patients were separated into 3 time periods for analysis: 2002 to 2005, 2006 to 2009, and 2010 to 2014. Recurrence outcomes were compared at 4 years between MAST+RECON patients.
  
  
  RESULTS
  Two thousand seventy-six patients were identified: 61.2% underwent BCT, 19.7% had MAST, and 19.1% had MAST+RECON. BCT patients were older and had smaller tumors. MAST+RECON increased in prevalence, whereas BCT decreased. Implant-based reconstruction and conservative mastectomy rates increased over the study period. Four-year local recurrence-free rates were similar in nipple-sparing and skin-sparing mastectomy groups.
  
  
  CONCLUSIONS
  BCT usage has decreased, trending toward immediate, nipple-sparing mastectomy, implant-based reconstruction. Surgeons should be aware of trends to optimally offer patients their surgical options.
authors.affiliation: Section of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Chang
authors.affiliation: Department of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Kosiorek
authors.affiliation: Department of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Amylou C
authors.initials: AC
authors.lastname: Dueck
authors.affiliation: Department of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Casey
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Alanna M
authors.initials: AM
authors.lastname: Rebecca
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Raman
authors.initials: R
authors.lastname: Mahabir
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Samir H
authors.initials: SH
authors.lastname: Patel
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Sameer R
authors.initials: SR
authors.lastname: Keole
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Wong
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Vargas
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Michele Y
authors.initials: MY
authors.lastname: Halyard
authors.affiliation: Section of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
authors.affiliation: Section of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.affiliation: Section of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
authors.forename: Chee-Chee H
authors.initials: CH
authors.lastname: Stucky
authors.affiliation: Section of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA. Electronic address: pockaj.barbara@mayo.edu.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000639:trends*; D008408:Mastectomy / Q000639:trends*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Breast cancer; Breast conserving therapy; Breast reconstruction; Mastectomy