Mastectomy Alone or with Immediate Breast Reconstruction: Trend, Precipitating Factors, Patients Reported Outcome, and Oncologic Safety Analysis with and without Propensity Score Matching from 3759 Mastectomy Patients.

Background: In the current study, we surveyed the trend of breast cancer operations in the past two decades and compared mastectomy alone or with immediate breast reconstruction (IBR) with the measurement of the outcome reported by patients and oncologic safety evaluation.

Methods: A retrospective study surveyed the trends in breast cancer surgery methods at a single institution between January 2000 and December 2021. Clinical manifestations, outcomes, patient-reported outcome measures, and oncologic safety evaluations between mastectomy alone or with IBR were analyzed, with and without propensity score matching (PSM).

Results: The trend of breast cancer operations showed that breast-conserving surgery (BCS) and mastectomy with IBR were increasing while mastectomy alone was decreasing. Among the 3759 patients who underwent mastectomies, 1091 (29%) patients had mastectomy with IBR while 2668 (71%) received mastectomy alone. In multivariate analysis, age less than 45 years, breast magnetic resonance imaging before surgery, luminal A subtype, nipple-sparing mastectomy, oncoplastic reconstructive breast surgeon, and high-volume surgeon were important independent factors for mastectomy with IBR. Mastectomy with IBR was associated with better patient-reported cosmetic results than mastectomy alone and comparable to BCS. After PSM and a median follow-up of 106.1 months, there was no difference in Kaplan-Meier survival curve analysis between patients who underwent mastectomy alone or mastectomy with IBR in terms of locoregional recurrence, distant metastasis or overall survival.

Conclusions: Mastectomy with IBR demonstrated better reported cosmetic outcomes and comparable oncologic safety compared to mastectomy alone. Independent factors promoting IBR were identified, which could help increase the breast reconstruction rate.

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