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.

Summary

In a 3,759-patient retrospective cohort with propensity score matching, immediate breast reconstruction after mastectomy improved patient-reported cosmetic outcomes without increasing locoregional recurrence, distant metastasis, or overall mortality over a median 106.1 months. Younger age, preoperative MRI, luminal A subtype, nipple-sparing technique, and high-volume/oncoplastic surgeons were independently associated with reconstruction.

Key Findings

• Among 3,759 mastectomy patients, 29% underwent immediate breast reconstruction; reconstruction rates increased over time while mastectomy alone decreased.
• Immediate reconstruction yielded better patient-reported cosmetic outcomes and outcomes comparable to breast-conserving surgery.
• After propensity score matching and median 106.1-month follow-up, no differences were observed in locoregional recurrence, distant metastasis, or overall survival versus mastectomy alone.

Clinical Implications

Supports offering immediate reconstruction to suitable candidates without compromising cancer control and highlights factors that may improve reconstruction access and outcomes.

Limitations

• Retrospective, single-institution design may introduce selection and practice-pattern biases.
• Reconstruction techniques and complication profiles are not detailed in the abstract.

Future Directions

Multi-center prospective studies to validate oncologic safety across reconstruction types and assess quality-of-life, cost-effectiveness, and equitable access.