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Introduction: Much research has been devoted to why women choose not to be reconstructed following mastectomy. The effect of breast size has not been well explored. The authors aimed to assess the relationship between breast size and reconstructive choices.
Methods: A single-center retrospective review of women undergoing mastectomy between 2011 and 2014 was performed. Demographics, surgical variables, and reconstruction decisions were analyzed using t-tests, Mann Whitney U tests, and χ² tests. Significant (p<0.05) variables were included in a multivariable logistic regression model.
Results: 610 patients were analyzed. The median mastectomy specimen weight was 572g (62-5230g), which did not correlate with BMI (p=0.44). Women who underwent reconstruction had lighter mastectomy specimens, averaging 643 versus 848g (p<0.0001). After controlling for ethnicity, insurance status, number of comorbidities, age at mastectomy, cancer stage, BMI, lower specimen weight (p=0.005), lower cancer stage (p=0.008), bilateral mastectomy (p=0.042), and younger age at mastectomy (p<0.0001) were significantly associated with reconstruction. When specimen weight was analyzed in 100 gram increments, each additional 100 grams decreased the likelihood of reconstruction by 10.0%; each year of age decreased it by 9.1%, and each increased cancer stage increased it by 39.4%. Undergoing bilateral mastectomies increased the likelihood of reconstruction by 76.8%. Figure 1 shows the relationship between breast size and reconstruction status with a Cochran-Armitage test for trends p value=0.0009312.
Small-breasted patients (<500 g) were more likely to have implant-based reconstruction (OR 2.53, 1.78-3.60) and large-breasted women (>1000 g) were more likely to have autologous reconstruction (OR 2.13, 1.35-3.34). ). Small-breasted patients (<500 g) were more likely to have a contralateral augmentation (OR 2.35, 1.00-5.53). Large breasted women (>1000 g) were more likely to have a contralateral reduction (OR 6.34, 2.79-14.38).
Conclusions: Women with larger breasts were less likely to be reconstructed regardless of their BMI and comorbidities. Larger-breasted women may be considered worse prosthetic reconstruction candidates due to increased complications and sub-optimal aesthetic outcomes but may find the increased invasiveness and recovery of autologous reconstruction an unattractive alternative. Further research must be done to determine why more larger-breasted women choose not to be reconstructed as well as develop better ways to increase their reconstructive options.