Associations between Breast Reconstruction Surgery vs. Mastectomy without Reconstruction on Postsurgical Radiation Treatment Modalities: a 2004-2018 NCDB Study

Background This study compares associations between breast reconstruction surgery (BRS) and types of postmastectomy radiation treatment modalities for breast cancer. Methods Utilizing the NCDB Breast participant use file (PUF) from 2004–2018, we compared the postmastectomy radiation treatment modalities of patients receiving BRS to those who did not. Results Our study suggests that BRS patients had greater odds of pursuing more advanced radiotherapy modalities, IMRT and 3D-CRT, compared to mastectomy without reconstruction (MWR) patients. BRS patients were 3.271 (95% CI 2.704–3.956) times more likely to receive Phase I 3D-CRT vs. 2D-therapy, and 3.421 (95% CI 2.817–4.154) times more likely to receive IMRT vs. 2D-therapy, with relatively equal rates of receiving IMRT compared to 3D-CRT (1.046; 95% CI 0.974–1.123). For Phase II, BRS patients were 1.590 (95% CI 1.490–1.698) times more likely to receive 3D-CRT vs. 2D therapy, 1.533 (95% CI 1.392–1.688) times more likely to receive IMRT vs. 2D therapy, and 1.159 (95% CI 1.111–1.208) times more likely to receive unspecified EBR vs. 2D therapy. Conclusions The choice of radiotherapy modality after breast reconstruction surgery is critical for ensuring optimal treatment efficacy and safety, as it depends on factors like the patient’s goals, anatomy, and preexisting conditions. Advanced techniques like IMRT and 3D therapies have shown increased usage in and potential promise for BRS patients due to their precision in sparing healthy tissues, highlighting the need for further research to improve outcomes for this population.