An Analysis of Immediate Postmastectomy Breast Reconstruction Frequency Using the Surveillance, Epidemiology, and End Results Database

Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
The Breast Journal (Impact Factor: 1.43). 05/2011; 17(4):352-8. DOI: 10.1111/j.1524-4741.2011.01105.x
Source: PubMed

ABSTRACT Mastectomy is used to treat one third of the nearly 180,000 women diagnosed with breast cancer in the United States annually. In this study, we use population-level data from multiple years of the Surveillance, Epidemiology, End Results (SEER) database to further define patient, tumor, and geographic characteristics associated with immediate and early-delayed breast reconstruction. Population level de-identified data for the years 1998 to 2002 were extracted from the National Cancer Institute's (NCI) SEER cancer database. All female patients who were treated with mastectomy for a diagnosis of ductal and/or lobular breast cancer (including Paget disease) were included. The primary end point of interest was odds of reconstruction. Multivariate analysis was performed to control for patient demographic and oncologic characteristics. A total of 52,249 patients met the inclusion criteria. Reconstruction was performed in 8,446 patients (16.2%). Odds of reconstruction varied by region from 0.60 (Seattle) to 2.81 (Atlanta). African Americans were noted to have a significantly lower likelihood of reconstruction when compared with Caucasian patients (OR 0.60 versus 1.00). Patients living in nonmetropolitan regions were also significantly less likely to undergo reconstruction. Receipt of radiation therapy was also negatively correlated with likelihood of reconstruction. In this multicenter, multiyear analysis of factors associated with immediate or early-delayed reconstruction after mastectomy, we demonstrate that younger age, white race, metropolitan locale, and lower stage disease were all independently associated with higher likelihood of reconstruction. This information provides insight into breast reconstruction utilization and will help guide future studies to understand how these factors affect patient and physician decision-making.

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    ABSTRACT: Background Immediate, implant-only breast reconstruction is traditionally discouraged in patients who receive radiation. It is not clear whether this widely recognized mantra of breast reconstruction is observed in practice. The purpose of this study was to evaluate immediate reconstruction trends and practices in patients who have undergone mastectomy and radiation therapy. Methods Female patients with unilateral breast cancer who required radiation in addition to mastectomy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 through 2010. Patients who underwent immediate reconstruction were identified and analyzed. Univariate and logistic regression analyses were performed to study the relationship between reconstructive method and patient demographic and oncologic characteristics. Results A total of 5,481 female patients who underwent radiation and breast reconstruction were included for analysis. Postmastectomy radiation therapy was performed in 98.3 % of the patients. The immediate breast reconstruction rate among patients requiring radiation increased from 13.6 to 25.1 %. The percentage of reconstructed patients who had implant-only reconstruction increased from 27 to 52 % (p p Conclusions The frequency of immediate reconstruction continues to increase in the setting of postmastectomy radiation therapy, with immediate implant-based reconstruction representing the most commonly utilized method, contrary to traditional recommendations. These findings likely reflect changing attitudes towards implant reconstruction in the setting of planned postmastectomy radiation.
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    ABSTRACT: Although guidelines exist for radiation delivery in the setting of mastectomy or breast-conservation therapy, radiation delivery after nipple-sparing mastectomy (NSM) remains variable. Our goal is to determine whether patients who undergo therapeutic NSM are more likely to receive radiation than patients who undergo non-NSM and whether National Comprehensive Cancer Network (NCCN) guidelines for radiation after mastectomy are observed in NSM patients. Female patients who underwent NSM or non-NSM for breast cancer from 2006 to 2010 were isolated from the Surveillance, Epidemiology, and End Results database. Univariate analysis stratified by tumor size and lymph node status, and multivariate analyses were used to compare odds of radiation in NSM and mastectomy patients. Adherence to NCCN guidelines based on tumor size and lymph node status was also investigated. A total of 112,817 patients were included: 470 (0.4 %) underwent NSM, and 112,347 (99.6 %) underwent non-NSM. NSM patients with 0 nodes/size a parts per thousand currency sign2 cm, 0 nodes/size 2-5 cm, and unexamined axilla/size a parts per thousand currency sign2 cm had higher odds of radiation when compared with size- and node-matched mastectomy patients. Multivariate logistic regression showed that NSM patients had higher odds of radiation (odds ratio 2.01, p < 0.001) than mastectomy patients. Radiation was given to 18 % of NSM patients who did not meet NCCN guidelines according to size or lymph node involvement, compared with 6 % of mastectomy patients. Patients who undergo therapeutic NSM are more likely to receive radiation compared with mastectomy patients. This may reflect a concern with leaving ductal tissue in the nipple-areolar complex.
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