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American Association of Plastic Surgeons

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Failed Breast Conservation Therapy Predicts Higher Frequency Of Revisionary Surgery Post-mastectomy With Reconstruction: An Analysis Of 6,288 Women
Clifford C. Sheckter, MD, Danielle Rochlin, MD, Arash Momeni, MD
Stanford, Mountain View, CA, USA.

PURPOSE: Breast conservation therapy (BCT) remains the gold standard for women with localized breast cancer; however, some women may eventually undergo mastectomy with reconstruction. Little is understood regarding the risks of failed BCT as they relate to post-mastectomy reconstruction and whether this affects outcomes.
METHODS: Patients undergoing implant or autologous breast reconstruction were extracted from a merged version of the Truven MarketScan inpatient and outpatient databases from 2007-2016. Frequency of lumpectomy and neoadjuvant radiation were determined per patient. Outcomes included inpatient complications (patient safety indicators) and frequency of revisionary procedures. Multivariable regression models were adjusted for age, obesity, method of reconstruction, timing of reconstruction, and Elixhauser comorbidity score.
RESULTS: 6,288 of 52,826 (11.9%) women underwent >1 lumpectomy prior to mastectomy with reconstruction. Of those undergoing lumpectomy, the mean lumpectomies/woman was 1.67+0.90. 3,334 (53.0%) of lumpectomy patients completed radiation therapy. The mean revisions/woman with BCT was 1.5 versus 1.3 in the general cohort. On multivariable analysis, lumpectomy alone was not associated with increased odds of inpatient complications (OR 1.07, p=0.363), nor was radiation therapy (OR 0.89, 95% CI 0.76-1.04, p=0.153). However, radiation with or without lumpectomy prior to mastectomy was a significant predictor of more frequent revisionary operations (p=0.032). Lumpectomy alone was not associated with an increased frequency of revisionary surgery (p=0.173).
CONCLUSION:
Failed BCT resulting in mastectomy with reconstruction was associated an increased risk for secondary revisionary surgery. Patients should be counseled accordingly prior to BCT in the event they may eventually undergo mastectomy with reconstruction.


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