Mastectomy plus reconstruction riskiest, costliest treatment option

OCTOBER 11, 2016 BY LAURA SUSSMAN

Mastectomy plus reconstruction for patients with early-stage breast cancer is significantly riskier and costlier than other less-invasive options, MD Anderson researchers have found. Their study, published Sept. 27 in the Journal of the National Cancer Institute, is the first to break down the complication rates and costs for breast cancer treatment options.

Women with early-stage breast cancer have a number of treatment options, including lumpectomy plus whole-breast irradiation, lumpectomy plus brachytherapy, mastectomy alone, or mastectomy plus reconstruction, or in older women, lumpectomy alone. These therapies offer equal survival profiles, explains Benjamin Smith M.D., the study’s principal investigator, but differ greatly in terms of what the patient endures.

“What our study shows for the first time is that while the patient is undergoing more surgery, she is also taking on a considerable amount of risk with regard to what could happen. If the patient can have a lumpectomy and radiation, it may be a smoother course than going through a mastectomy, reconstruction and potentially other surgeries,” explained Smith, associate professor of Radiation Oncology and Health Services Research.

Data from more than 100,000 patients showed those who had surgery to remove all breast tissue and then rebuild the breast were almost twice as likely to suffer complications than those who had only the abnormal tissue removed, followed by radiation.

Smith thinks that this type of data will provide guidance for insurance companies as they start to think about bundled payments for breast cancer care. He also believes that these findings will help be patients understand the tradeoffs between therapies.

“Until now, there’s been little data to understand the differences in complications between these treatment options, and even less data to understand the differences in cost between those options. It was important that we try to quantify their complication profile and cost, both for patients making these decisions and for payers.”

Despite the findings, Smith stresses that for some early breast cancer patients, mastectomy plus reconstruction is truly their best treatment option, and that these research findings should not be used to decrease reimbursement or coverage for mastectomy plus reconstruction when medically indicated.

Read more about this study in MD Anderson’s newsroom.