Effects of breast reconstruction modality on survival outcomes in breast cancer patients

Background Implant-based breast reconstruction (IBBR) remains the mainstream approach for post-mastectomy breast reconstruction. Given the iterative innovations in IBBR techniques, the impact of varying surgical methods on patient outcomes requires renewed scrutiny. Objective To compare the effects of different surgical approaches and implant planes on survival outcomes in patients with breast cancer undergoing IBBR. Methods This retrospective cohort study included 398 patients with invasive breast cancer who underwent IBBR. Patients were categorized according to the surgical approach into the endoscopic group (n = 188) and the open group (n = 210), and according to the implant plane into the pre-pectoral group (n = 170) and the sub-pectoral group (n = 228). The primary outcomes were overall survival (OS) and recurrence-free survival (RFS), and the secondary outcome was the occurrence of postoperative complications. Results The median follow-up duration of the included 398 patients was 62 months. During follow-up, 58 patients (14.57%) experienced recurrence or metastasis, and 42 (10.55%) died. The 5-year RFS and 5-year OS rates were similar between the endoscopic and open groups, as well as between the pre-pectoral and sub-pectoral groups (log-rank P > 0.05), which was supported by multivariable Cox regression (all P > 0.05). Seroma was less common in the endoscopic group (P < 0.05) and breast dynamic deformity in the pre-pectoral group (P < 0.05), but overall and severe complications did not differ between groups (P > 0.05). In the radiotherapy subgroup, the pre-pectoral group had a significantly lower rate of overall complications than the sub-pectoral group (P = 0.004), mainly due to lower capsular contracture (P < 0.05), while no significant differences were found for the remaining complications between the two implant planes. Conclusions In IBBR, neither the choice of surgical approach nor the implant plane was observed to be significantly associated with survival outcomes or overall complications in patients with breast cancer. Pre-pectoral implant placement may be associated with a lower risk of capsular contracture in patients receiving postoperative radiotherapy; however, this finding was derived from a small observational subgroup analysis and should be interpreted with caution.