# Impact of breast reconstruction and different surgical approaches after neoadjuvant therapy on the long-term survival of breast cancer patients

## TL;DR

Breast reconstruction after a specific type of mastectomy improves long-term survival in breast cancer patients who received pre-surgery therapy.

## Contribution

Shows that nipple-sparing mastectomy with breast reconstruction improves survival compared to mastectomy alone in specific patient subgroups.

## Key findings

- NSM with BR is linked to better overall and breast cancer-specific survival than TM alone.
- The survival benefit of NSM with BR remains significant after statistical matching and multiple models.
- Younger patients and those with favorable tumor features benefit most from NSM with BR.

## Abstract

•Provides robust long-term survival data from a large-scale study, addressing the impact of Breast reconstruction (BR) on survival outcomes after neoadjuvant therapy (NAT).•BR after Nipple-sparing mastectomy (NSM) results in better overall survival (OS) and breast cancer-specific survival (BCSS) compared to TM alone. This association remained significant across propensity score matching (PSM) and multiple association inference models (Table 4).•Specific subgroups, such as younger patients, married patients, those with fewer lymph node metastases, favorable tumor pathology, and timely diagnosis, benefit most from BR after NSM. This suggests personalized treatment strategies for breast cancer patients.

Provides robust long-term survival data from a large-scale study, addressing the impact of Breast reconstruction (BR) on survival outcomes after neoadjuvant therapy (NAT).

BR after Nipple-sparing mastectomy (NSM) results in better overall survival (OS) and breast cancer-specific survival (BCSS) compared to TM alone. This association remained significant across propensity score matching (PSM) and multiple association inference models (Table 4).

Specific subgroups, such as younger patients, married patients, those with fewer lymph node metastases, favorable tumor pathology, and timely diagnosis, benefit most from BR after NSM. This suggests personalized treatment strategies for breast cancer patients.

Large-scale studies on long-term survival after breast reconstruction (BR) following neoadjuvant therapy (NAT) are limited. This study compares long-term survival in breast cancer patients who had BR after NAT—either with nipple-sparing mastectomy (NSM) or total mastectomy (TM)—versus TM alone, to identify subgroups most likely to benefit.

We analyzed female breast cancer patients who received NAT in the SEER database, stratifying them into three groups: NSM with BR (n = 949), TM with BR (n = 3554), and TM without BR (n = 5465). Overall survival (OS) and breast cancer–specific survival (BCSS) were assessed using Cox proportional hazards models and propensity score matching (PSM).

A total of 9968 patients were included in this study. Compared with TM alone, patients who underwent TM with BR had similar OS (Model 4, Table 3) and BCSS (HR: 0.90–0.96; all P > .05; Table 3). However, those who underwent NSM with BR were associated with better OS (HR: 0.29–0.60; all P < .05; Table 3) and BCSS (HR:0.31–0.64; all P < .05; Table 3). This association remained significant across PSM and multiple association inference models (Table 4) and was more robust in prespecified subgroups—including those aged <65 years and those with earlier-stage disease (Figure 3).

This nationwide cohort study shows that, among patients receiving NAT, NSM with BR is associated with better OS and BCSS than TM alone—whereas TM with BR showed no survival benefit. NSM with BR is a feasible option for selected patients and warrants prospective validation.