Impact of lymph node status on the prognosis of female breast cancer patients who underwent immediate reconstruction after total mastectomy: A multi-institutional retrospective cohort study

Purpose This study aims to evaluate the impact of lymph node status on survival outcomes in female breast cancer patients underwent immediate breast reconstruction (IBR) after mastectomy. Methods Data from 8,418 cases (2010–2017) receiving IBR were divided into regional lymph node negative (LN-) and positive (LN+) groups. Propensity score matching (PSM) was used to balance covariates between groups. Subgroup Cox regression analysis was performed to assess overall survival (OS) and breast cancer-specific survival (BCSS), considering sociodemographic, oncological, and treatment-related factors. Results In patients underwent IBR, the LN + group exhibited significantly poorer OS and BCSS than the LN- group, both before and after PSM. Higher income, specific tumor characteristics, and implant-based reconstruction were related to better survival outcomes. Subgroup analysis revealed that in LN- group, lower income, HR-, HER2- status, and higher tumor grade were OS/BCSS risk factors. In the LN + group, advanced T stage independently predicted worse OS/BCSS, and contralateral breast removal was associated with a decrease in OS risk. Conclusions LN + status is a significant adverse prognostic factor in IBR patients. Personalized treatment strategies based on LN status are essential for optimizing survival outcomes.