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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2019

01-10-2019 | Mastectomy | Breast Oncology

National Patterns of Breast Reconstruction and Nipple-Sparing Mastectomy for Breast Cancer, 2005–2015

Authors: Stephanie M. Wong, MD, MPH, Yoon S. Chun, MD, Yasuaki Sagara, MD, MPH, Mehra Golshan, MD, Jessica Erdmann-Sager, MD

Published in: Annals of Surgical Oncology | Issue 10/2019

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Abstract

Background

The purpose of this study was to explore national patterns in the uptake of breast reconstruction and nipple-sparing mastectomy (NSM).

Methods

We used the National Cancer Database to identify all women who underwent mastectomy for stage 0–III breast cancer between 2005–2015. Multivariable logistic regression was used to determine factors associated with receipt of reconstruction, with subset analyses performed to determine trends and predictors of NSM in those who underwent mastectomy with reconstruction.

Results

Our cohort consisted of 395,815 women, 238,568 (60.3%) who underwent mastectomy alone and 157,247 (39.7%) who underwent mastectomy followed by reconstruction. The use of breast reconstruction increased from 22.3% of mastectomy cases in 2005 to 49.7% of mastectomy cases in 2015 (odds ratio [OR] 9.7, 95% confidence interval [CI] 7.3–12.8). Among those receiving reconstruction, the use of NSM increased from 1.7% in 2005 to 14.3% in 2015 (OR 9.4, 95% CI 7.1–12.5), with increased utilization among those with early-stage and locally advanced disease, such that by 2015, NSM was performed in 15.3% of mastectomies with reconstruction for DCIS, 14.3% of mastectomies with reconstruction for stage I–II breast cancer, and 10.7% of mastectomies with reconstruction for stage III breast cancer. Factors strongly predicting receipt of NSM included age < 45 years, smaller clinical tumor size, clinically node negative disease, use of neoadjuvant therapy, and facility type.

Conclusions

There has been a dramatic increase in the use of breast reconstruction and NSM between 2005–2015. Further prospective studies evaluating oncologic outcomes of NSM in locally advanced breast cancer are warranted.
Appendix
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Metadata
Title
National Patterns of Breast Reconstruction and Nipple-Sparing Mastectomy for Breast Cancer, 2005–2015
Authors
Stephanie M. Wong, MD, MPH
Yoon S. Chun, MD
Yasuaki Sagara, MD, MPH
Mehra Golshan, MD
Jessica Erdmann-Sager, MD
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07554-x

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