Ten-Year Trends in Post-Mastectomy Reconstruction: A Community-Based Experience
*Kamal Addagatla, *Rishi Mamtani, *Leif Nordberg
Stamford Hospital, Stamford, CT
Objective Geographic distance from academic centers is a known barrier to post-mastectomy reconstruction (PMR). Evaluated long-term trends and outcomes in PMR.
Design Retrospective observational study. Median follow-up of 4.8 years (range 1 - 125 months).
Setting Community hospital.
Patients All mastectomy patients with or without immediate PMR from 2005-2016. 471 met criteria. 216 unilateral mastectomies and 255 bilateral mastectomies.
Main Outcome Measure Rates of immediate PMR and surgical outcomes.
Results - Of 726 mastectomies, 488 (67%) done for malignancy and 238 (33%) prophylactically
- Immediate PMR performed after 534 of 726 (74%) of all mastectomies.
- Annual PMR rates showed moderate variation, from 62% to 84% (p=0.74)
- PMR patients were younger (median age 56 vs. 75 years, p<0.001), less frequently diabetic (7% vs. 15%, p=0.001) and often prophylactic (40% vs. 13%, p<0.001)
- Among 534 PMRs, 473 (89%) implant based and 61 (11%) autologous
- Wound infection, flap necrosis, or loss of implant documented in 91 (17%) cases, 75 (14%) necessitating re-operation
- Laser angiography flap evaluation performed in 69 (13%) cases, with wound complications in 3 (4%) cases
- 488 mastectomies performed for malignancy, 249 (51%) received chemotherapy, 163 (33%) radiotherapy, and 269 of 379 ER+ patients (71%) received endocrine therapy
- 4 (0.8%) isolated locoregional recurrences, 4 (0.8%) combined locoregional/distant recurrences, and 79 (16%) distant-only recurrences
Conclusions The landscape of PMR remains in evolution. The need to address geographic barriers to reconstruction is paramount. Community centers with appropriate plastic surgery support have potential to play a key role in addressing this unmet need.