In a prospective cohort study reported by Jagsi et al in the Journal of the National Cancer Institute, autologous reconstruction was associated with fewer complications and greater patient satisfaction vs implant approaches in women receiving postmastectomy radiotherapy.
The study involved data from women diagnosed with breast cancer between 2012 and 2015 and undergoing breast reconstruction at 11 centers participating in the Mastectomy Reconstruction Outcomes Consortium, including 622 women undergoing and 1,625 not undergoing postmastectomy radiotherapy. A multivariate analysis assessed the impact of reconstruction type and radiotherapy on outcomes after adjustment for relevant covariates.
Complication Risk and Patient Satisfaction
Autologous reconstruction was more common (37.9% vs 25.0%, P < .001) and immediate reconstruction less common (83.0% vs 95.7%, P < .001) among irradiated patients. At least one breast complication occurred within 2 years in 38.9% of irradiated patients with implant reconstruction, 25.6% of irradiated patients with autologous reconstruction, 21.8% of nonirradiated patients with implant reconstruction, and 28.3% of nonirradiated patients with autologous reconstruction.
On a multivariate analysis, bilateral treatment and higher body mass index were associated with a greater risk of complications, with a statistically significant interaction between radiotherapy and reconstruction type. Among irradiated patients, autologous reconstruction was associated with a lower risk of complications vs implant-based reconstruction at 2 years (odds ratio [OR] = 0.47, P = .007), whereas no difference between procedure types was observed among nonirradiated patients. A significant interaction for satisfaction with breasts at 2 years (P = .002) was also observed, with adjusted differences between autologous vs implant approaches being 63.5% vs 47.7% among irradiated patients compared with 67.6% vs 60.5% among nonirradiated patients.
The investigators concluded: “Autologous reconstruction appears to yield superior patient-reported satisfaction and lower risk of complications than implant-based approaches among patients receiving postmastectomy radiotherapy.”
The study was supported by grants from the National Cancer Institute.
Reshma Jagsi, MD, DPhil, of the Department of Radiation Oncology, University of Michigan, Ann Arbor, is the corresponding author of the Journal of the National Cancer Institute article.
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