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Does the Type of Reconstruction Matter After Oncologic Mastectomy? Systematic Review of Propensity Matched Data Systematic Review of Propensity Matched Data
Abdulaziz Elemosho MD, Jude Kluemper BS, Syed Ali Farhan MD, Kerry-Ann Mitchell MD/PhD, Roman Skoracki MD
Ohio State University
2024-01-15
Presenter: Abdulaziz Elemosho MD
Affidavit:
"I certify that the work presented here is the original work of Zed and other members of the Mitchell Lab. And this work has not been presented at any other meeting"
Director Name: Gregory Pearson MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction:
Annually, over 100,000 breast reconstructions are performed in the US, with implant-based reconstruction constituting 45-70%, and the rest using autologous flaps. While safety is reported in both approaches for breast cancer patients, studies directly comparing the two methods are limited. This systematic literature review is the first to explore the long-term survival of breast cancer patients, utilizing propensity-matched data for this comparison.
Methods:
A thorough literature search of major databases employing various search queries and mesH headings was conducted. Only propensity-matched case-control studies comparing patients with implant-based and flap-based reconstruction were included.
Results:
Four studies meeting inclusion criteria included 2974 post-mastectomy breast reconstruction patients. Implant-based reconstruction was performed in 1417 (47.6%), while 1557 (52.4%) had autologous reconstruction with different flaps. Locoregional recurrence was reported in 91 (6.4%) patients in the implant group and 106 (6.8%) patients in the autologous group. Locoregional recurrence rates were comparable between groups [OR:1.02; 95% CI: 0.76-1.38; P=0.88]. The implant group exhibited a non-significant lower rate of distant metastasis [OR: 0.91; 95% CI: 0.64-1.28; P=0.58]. Disease-free survival was similar [RR:1.00; 95% CI: 0.97-1.03; P=0.99].
Conclusion:
This data indicates comparable outcomes for both reconstruction types; however, implant-based reconstruction may be preferable in patients with high-grade aggressive tumors. It emphasizes the importance of providing this information to patients for informed reconstruction choices. We recommend more RCTs and multicenter studies to properly delineate this association.
