Do breast implants after a mastectomy affect subsequent prognosis and survival?

In this issue of Breast Cancer Research, Le and colleagues [1] report on an important issue, namely the survival experience of women receiving breast implants after mastectomies for early-stage breast cancer. Although the long-term health effects associated with cosmetic breast implants have been extensively debated, less attention has focused on reconstructive implants [2]. Clarification of effects is important, given the impaired survival of women with breast cancer and the fact that increasing numbers of women are choosing reconstruction to improve their quality of life after mastectomy.In an investigation that had several strengths, including a relatively large size, a focus on a nationally representative group of patients, long-term follow-up and available information on types of implants, it was found that one-fifth of women diagnosed with early-stage breast cancers received post-mastectomy implants. Although these women were found to have a significantly lower all-cause mortality and lower mortality from breast cancer, the interpretation of these relationships is complex, necessitating an evaluation of both the characteristics of the women who decide to seek reconstructive surgery and the effects of medical factors associated with their diagnoses. The authors discuss limitations of their data, but there is in fact substantial evidence that several of these might have seriously hindered the true interpretation of the effects of reconstructive implants.It is notable that only a limited amount of information was available on patient characteristics associated with the seeking of implants. It was clear from information presented that women who obtained implants had several unique attributes. Notably, they tended to be younger and non-Hispanic whites, which is consistent with observations made elsewhere about unique attributes of women obtaining reconstructive surgery [3-5]. Although it was possible in analyses to account for both age and race, of concern was the