Breast Reconstruction in Male Breast Cancer Patients: An analysis of trends using the NSQIP database

Background: Rates of breast reconstruction in males with breast cancer have yet to be defined. Despite extensive literature on breast reconstruction in females, a paucity of studies exists for male patients. The aim of this study is to assess the incidence and trends in breast reconstruction in males with breast cancer using the National Surgical Quality Improvement Project (NSQIP) database. Methods: The 2005 to 2016 NSQIP database was queried to identify males with breast cancer who underwent partial or total mastectomy. Males who underwent post-mastectomy reconstruction were compared to those who did not. Primary outcomes included postoperative complications and mortality. Results: A total of 1,167 males underwent breast surgery, of which 73 (6.3%) underwent reconstruction within 30 days. The majority of patients receiving reconstruction were Caucasian (74.0%) followed by African-American (11.0%), and Asian (5.5%). Asian males had the highest rate of post-mastectomy reconstruction (n = 4, 13.8%). Males who underwent reconstruction had higher rates of postoperative wound dehiscence compared to those who did not undergo reconstruction (2.7% vs. 0%, p = 0.004). The most common reconstructive procedure was implant-based reconstruction (n = 37, 50.7%). African-American males tended to have less implant-based reconstruction than Caucasian (p = 0.057) and Asian males (p = 0.019). African- American males tended to have more free flap reconstruction than Caucasian males (p = 0.034). Conclusions: Post-mastectomy reconstruction is rarely performed in males with breast cancer. Most males undergo implant-based reconstruction, although racial differences exist. Further studies are warranted to assess long-term reconstruction and psychosocial outcomes in males who undergo breast reconstruction. Level of evidence: Level III, Diagnostic study.