Immediate Breast Reconstruction Does Not Have a Clinically Significant Impact on Adjuvant Treatment Delay and Subsequent Survival Outcomes

Abstract

Purpose The use of immediate breast reconstruction (IBR) has been debated because it may be a causative factor in adjuvant treatment delay and may subsequently increase the probability of recurrence. We investigated whether IBR was related to adjuvant treatment delay and survival outcomes. Methods We retrospectively analyzed the duration from operation to adjuvant treatment administration and survival outcomes according to IBR status among patients with breast cancer who underwent mastectomy followed by adjuvant chemotherapy from January 2005 to December 2014. Propensity score matching was performed to balance the clinicopathologic baseline characteristics between patients who did and did not undergo IBR. Results Of 646 patients, 107 (16.6%) underwent IBR, and the median follow-up was 72 months. The median duration from surgery to adjuvant chemotherapy was significantly longer in patients who underwent IBR than in those who did not (14 vs. 12 days, respectively, p = 0.008). Based on propensity score matching, patients who underwent IBR received adjuvant therapy 3 days later than those who did not (14 vs. 11 days, respectively, p = 0.044). The duration from surgery to post-mastectomy radiation therapy (PMRT) did not significantly differ between the 2 groups. Local recurrence-free survival, regional recurrence-free survival, systemic recurrence-free survival, and overall survival were also not significantly different between the 2 groups ( p = 0.427, p = 0.445, p = 0.269, and p = 0.250, respectively). In the case-matched cohort, survival outcomes did not change. Conclusion IBR was associated with a modest increase in the duration from surgery to chemotherapy that was statistically but not clinically significant. Moreover, IBR had no influence on PMRT delay or survival outcomes, suggesting that it is an acceptable option for patients with non-metastatic breast cancer undergoing mastectomy.

Does chemotherapy or radiotherapy affect the postoperative complication in breast cancer patients who underwent immediate breast reconstruction with tissue expander?

“…Several studies have demonstrated oncologic safety in the patients who underwent IR following mastectomy [ 14 – 16 ]. In addition, the majority of previous studies on the impact of chemotherapy or radiotherapy on postoperative complications after immediate breast reconstruction reported that chemotherapy or radiotherapy did not increase postoperative complications and immediate breast reconstruction did not affect the initiation of adjuvant treatment [ 5 , 8 – 11 , 17 – 24 ]. This study also reported that chemotherapy or radiotherapy did not affect postoperative complications in the patients who underwent immediate breast reconstruction with tissue expander.…”

Does Chemotherapy or Radiotherapy Affect for Postoperative Complication in Patients Who Underwent Immediate Breast Reconstruction With Tissue Expander?

“…Several studies have demonstrated oncologic safety in the patients who underwent IR following mastectomy [11][12][13]. In addition, the majority of previous studies on the impact of chemotherapy or radiotherapy on postoperative complications after immediate breast reconstruction reported that chemotherapy or radiotherapy did not increase postoperative complications and immediate breast reconstruction did not affect the initiation of adjuvant treatment [3,[7][8][9][10][14][15][16][17][18][19][20][21]. This study also reported that chemotherapy or radiotherapy did not affect postoperative complications in the patients who underwent immediate breast reconstruction with tissue expander.…”

“…Breast reconstruction after mastectomy has a positive impact on patients' psychosocial and sexual wellbeing. Moreover, immediate breast reconstruction can provide patients with the opportunity to reduce one additional surgery and costs instead of undergoing two separate procedures [1][2][3][4][5][6].…”

Does chemotherapy or radiotherapy affect the postoperative complication in patients who underwent immediate breast reconstruction with tissue expander?

“…Several studies have demonstrated oncologic safety in the patients who underwent IR following mastectomy [15][16][17]. In addition, the majority of previous studies on the impact of chemotherapy or radiotherapy on postoperative complications after immediate breast reconstruction reported that chemotherapy or radiotherapy did not increase postoperative complications and immediate breast reconstruction did not affect the initiation of adjuvant treatment [5,[9][10][11][12][18][19][20][21][22][23][24][25]. This study also reported that chemotherapy or radiotherapy did not affect postoperative complications in the patients who underwent immediate breast reconstruction with tissue expander.…”

“…Breast reconstruction after mastectomy has a positive impact on patients' psychosocial and sexual well-being. Moreover, immediate breast reconstruction can provide patients with the opportunity to reduce one additional surgery and costs instead of undergoing two separate procedures [3][4][5][6][7][8].…”