Abstract
Breast reconstruction is increasingly requested in breast cancer surgery, particularly among young women. However, the criteria for its feasibility need to be more clearly defined. This study aimed to compare the surgical safety and long-term oncologic survival outcomes between immediate breast reconstruction (IBR) and conventional mastectomy (CMx) and to determine the main factors affecting recurrence, considering tumor-specific features. The study analyzed 297 patients with locally advanced breast cancer (stage IIB-IIIC and/or axilla positive) who underwent CMx or IBR between January 2015 and December 2021 at Istanbul University, Oncology Institute, and mainly investigated the outcomes of both surgical interventions regarding recurrence and survival rates. The study examined 132 patients who underwent the CMx and 165 with the IBR procedure. Median follow-up was 60.2 months (range, 12-107). On average, younger patients (43.36 vs 50.42, P < .001) and patients with relatively early-stage tumors (P = .007, for cT and P = .004, for cN) underwent the IBR procedure more often compared with CMx. There was no difference between the 2 groups regarding other tumor-specific characteristics, receptor profiles, regimens of neoadjuvant chemotherapy, response to neoadjuvant chemotherapy, and adjuvant therapies (P > .05 for each comparison). The definitive pT stage had the highest risk for local recurrence, with a 3.2-fold increased risk independent of the type of surgery performed (P < .001, 3.22 (1.56-6.66)). However, no difference was between the IBR and CMx groups regarding local recurrence (84.8% vs 85.6%), distant metastasis (81.2% vs 79.5%), free survival rates, and overall survival (94.95 months vs 93.47 months, P = .916). Immediate breast reconstruction is a safe and feasible approach in patients with locally advanced breast cancer receiving neoadjuvant therapy compared to CMx alone, as it does not affect recurrence rates and survival.