Exploring Breast Reconstruction in Late-stage Breast Cancer Patients.

Background: Breast reconstruction after mastectomy improves quality of life for breast cancer patients. As more late-stage patients undergo reconstruction, it is essential to understand how treatment regimens and radiation impact outcomes. This study compared early- and late-stage breast cancer patients, examining comorbidities, reconstructive details, complications, and satisfaction. Methods: A total of 989 patients (903 early-stage; 86 late-stage) who underwent breast reconstruction between January 2011 and February 2025 were reviewed. Cancer staging followed the National Cancer Institute definitions: early-stage (I-IIIA) and late-stage (IIIB-IV). Results: Late-stage patients had higher rates of diabetes (P = 0.003), neoadjuvant chemotherapy (P < 0.001), and radiation (P < 0.001), whereas early-stage patients more often received adjuvant hormonal therapy (P = 0.006). Hormone receptor profiles differed: late-stage patients were more likely to be human epidermal growth factor receptor 2-positive (P < 0.001), whereas early-stage patients were estrogen receptor-positive (P < 0.001) and progesterone receptor-positive (P = 0.004). Early-stage patients more often underwent 2-stage expander reconstruction (P = 0.002) and implant-based reconstruction (P = 0.039), whereas late-stage patients more frequently had delayed reconstruction (P < 0.001). There were no significant differences in implant, flap, or donor-site complications, or in BREAST-Q satisfaction scores. Conclusions: Breast reconstruction is feasible and safe in late-stage breast cancer patients. Despite greater comorbidities and more aggressive disease, late-stage patients achieve complication rates and satisfaction comparable to early-stage patients. Future research should refine protocols to address the specific needs of late-stage patients, emphasizing quality of life and patient-centered outcomes.