Long-Term Oncologic Safety of Immediate Reconstructive Surgery in Patients with Invasive Breast Cancer: A Retrospective Matched-Cohort Study

Abstract Objective Immediate reconstruction (IR) is a safe and effective surgical treatment for patients with breast cancer. We aimed to assess the prognosis, aesthetic outcomes, and patient satisfaction of IR compared with breast conservation surgery (BCS) and total mastectomy (TM).Methods In this retrospective matched-cohort study, we established two cohorts according to the tumor (T) size of breast cancer. In the T≤3cm group, cases (IR) and controls (BCS or TM) were matched for age, pathological tumor size and pathologic nodal status in a 1:1:1 ratio. In the T>3cm group, cases (IR) and controls (TM) were matched with the same factors and ratio. The primary outcome was the 5-year disease-free survival (DFS). The secondary outcome was patient satisfaction and quality of life.Results Between May, 2005 and December, 2014, total 12,678 breast cancer patients were assessed, of which 587 were included (T≤3 cm group: 155 IR vs 155 BCS vs 155 TM; T>3cm group: 61 IR vs 61 TM). In the T≤3 cm cohort, patients underwent IR had no difference compared with those underwent BCS or TM regarding the 5-year DFS (P=0.539); however, an improved aesthetic satisfaction, psychosocial and sexual well-being were achieved in the IR group (P＜0.001). In the T>3 cm cohort, IR group had a worse median 5-year DFS (P=0.044), especially for Her2+ or triple-negative breast carcinoma (TNBC) subtypes compared with TM group. Conclusions IR improves aesthetic satisfaction, psychosocial and sexual well-being for breast cancer patients with T≤3 cm. However, Her2+ or TNBC predict a worse 5-year DFS in the T>3 cm group.