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Background
There has been little studied in the way of early postoperative outcomes comparing breast conservation surgery (BCS) and simple mastectomy with implant reconstruction. Such information would guide treatment strategy, facilitate decision making, and improve a surgeon’s ability to provide informed consent to patients requiring treatment. This would be particularly useful for women who have early stage breast cancer and have the choice between BCS or simple mastectomy followed by reconstruction with implants. Our goal was to compare early postoperative outcomes from the National Surgical Quality Improvement Program (NSQIP) database in BCS versus simple mastectomy with implant reconstruction for early stage breast cancer.
Methods
The NSQIP database from years 2009 to 2012 was analyzed, and patients were selected that underwent partial or complete mastectomy with sentinel lymph node biopsy. Patients were divided into two treatment groups depending on CPT codes: breast conservation surgery, and simple mastectomy with concurrent implant reconstruction. We excluded patients that underwent axillary lymph node dissections, had received prior radiation therapy, underwent concurrent autologous tissue reconstructive surgery, underwent concurrent surgeries in addition to the primary surgeries being studied, or had certain baseline health complications that could confound postoperative complication rates. We compared both pre-operative co-morbidity differences and postoperative complication rates in each group using Chi Square and two sample t-tests to determine significance, as well as determined odds ratios for the likelihood of adverse events in a number of categories.
Results
Inclusion and exclusion criteria provided a total of 2,414 patients with 1,799 patients in the BCS group and 615 patients in the simple mastectomy with implant reconstruction group (480 with implant after tissue expansion, and 135 with direct implant). Baseline co-morbid condition characteristics showed statistical differences between each group for age (61.6 yrs in BCS, 51.9 yrs in mastectomy with implant), hypertension (46.1% in BCS, 22.8% in mastectomy with implant), COPD status (2.3% in BCS, 0.5% in mastectomy with implant), and diabetes (11.5% in BCS, 4.9% in mastectomy with implant). Table 1 demonstrates the statistical analysis between each treatment modality noting that the mastectomy with reconstruction group had significantly higher wound (4.1% vs 1.4% in BCS) and infection (1.1% vs 0.3% in BCS) rates than the BCS group.

TABLE 1 Frequency of 30-day postoperative complications in patients with partial mastectomy and SLNB versus complete simple mastectomy and SLNB w/ reconstruction and implant
Complication	Partial mastectomy and SNLB n (%)		Complete mastectomy and SLNB w/ tissue expander & implant n (%)		Complete mastectomy and SLNB w/ direct implant n (%)		Total mastectomy and SLNB w/ implant reconstruction (%)		OR (95% CI) (Partial mast vs total implant)
Overall	36 (2.0)		28 (5.8)		8 (5.9)		36 (5.9)		3.0 (1.9 - 4.9)
Wounda	26 (1.4)		20 (4.2)		5 (3.7)		25 (4.1)		2.9 (1.7 - 5.0)
Infectiousb	6 (0.3)		4 (0.8)		3 (2.2)		7 (1.1)		3.4 (1.2 - 10.3)
Respiratoryc	0 (0.0)		0 (0.0)		0 (0.0)		0 (0.0)		NA
Thromboembolicd	2 (0.1)		1 (0.2)		0 (0.0)		1 (0.2)		1.5 (0.1 - 16.2)
Renale	0 (0.0)		0 (0.0)		0 (0.0)		0 (0.0)		NA
Neurologicf	1 (0.1)		0 (0.0)		0 (0.0)		0 (0.0)		NA
Cardiacg	0 (0.0)		0 (0.0)		0 (0.0)		0 (0.0)		NA
Bleedingh	1 (0.1)		3 (0.6)		0 (0.0)		3 (0.5)		8.8 (0.9 -84.9)
SLNB sentinel lymph node biopsy, OR odds ratio, CI confidence interval, NA not applicable a Superficial surgical site infection (SSI), deep SSI, or wound dehiscence b Organ space SSI, pneumonia, urinary tract infections, sepsis, or septic shock c Failure to wean, reintubation or intraoperative anesthetic complications d Deep vein thrombosis or pulmonary embolism e Acute renal failure or progressive renal insufficiency f Coma, peripheral nerve deficit, or cerebral vascular accident g Myopcardial infarction or cardiac arrest h Pre- or postoperative bleeding requiring transfusions

Conclusion
While both BCS and simple mastectomy with implant reconstruction options have low overall early post operative complication rates when treating early stage breast cancer, BCS has fewer overall early post operative complications with regards to wound complications and infections, despite a higher percentage of pre-existing co-morbid conditions.