title: National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy.
abstract: BackgroundImmediate breast reconstruction (IBR) is often deferred, when postmastectomy radiotherapy (PMRT) is anticipated, due to high complication rates. Nonetheless, because of robust data supporting improved health-related quality of life associated with reconstruction, physicians and patients may be more accepting of tradeoffs. The current study explores national trends of IBR utilization rates and methods in the setting of PMRT, using the National Cancer Database (NCDB). The study hypothesis is that prosthetic techniques have become the most common method of IBR in the setting of PMRT.MethodsNCDB was queried from 2004 to 2013 for women, who underwent mastectomy with or without IBR. Patients were grouped according to PMRT status. Multivariate logistic regression was used to calculate odds of IBR in the setting of PMRT. Trend analyses were done for rates and methods of IBR using Poisson regression to determine incidence rate ratios (IRRs).ResultsIn multivariate analysis, radiated patients were 30% less likely to receive IBR (p< 0.05). The rate increase in IBR was greater in radiated compared with nonradiated patients (IRR: 1.12 vs. 1.09). Rates of reconstruction increased more so in radiated compared with nonradiated patients for both implants (IRR 1.15 vs. 1.11) and autologous techniques (IRR 1.08 vs. 1.06). Autologous reconstructions were more common in those receiving PMRT until 2005 (p< 0.05), with no predominant technique thereafter.ConclusionAlthough IBR remains a relative contraindication, rates of IBR are increasing to a greater extent in patients receiving PMRT. Implants have surpassed autologous techniques as the most commonly used method of breast reconstruction in this setting.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Shantanu N
authors.initials: SN
authors.lastname: Razdan
authors.affiliation: Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.affiliation: Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Albornoz
authors.affiliation: Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.affiliation: Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Hina J
authors.initials: HJ
authors.lastname: Panchal
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Alice Y
authors.initials: AY
authors.lastname: Ho
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Adeyiza O
authors.initials: AO
authors.lastname: Momoh
authors.affiliation: Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
mesh_terms: D000328:Adult; D018427:Breast Implants / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016208:Databases, Factual; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000706:statistics & numerical data* / Q000639:trends; D008408:Mastectomy; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States