Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

Introduction: Therapeutic mammaplasty (TM) may be an alternative to mastectomy but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR.
Method: The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified and demographic, complication, oncology, and adjuvant treatment data compared to patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast conserving surgery (BCS) in the TM group. Secondary outcomes included post-operative complications and time to adjuvant therapy.
Results: 2,916 patients; (TM n=376; mastectomy n=1532; IBR n=1008; [implant-based n=675; pedicled-flap n=105; free-flap n=228]) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those undergoing IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM n=79, 21.0%; mastectomy n=570, 37.2%; mastectomy and IBR n=359, 35.6%; p<0.001). Breast conservation was possible in 87% of TM patients. TM did not delay adjuvant treatment.
Conclusion: TM may allow high-risk patients who would not be candidates for IBR to safely avoid mastectomy. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches and to establish long-term oncological safety.