The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Abstract

on behalf of the iBRA-2 Steering Group and the Breast Reconstruction Research Collaborative BACKGROUND: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise longterm outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. METHODS: Consecutive women undergoing mastectomy ± IBR for breast cancer July-December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. RESULTS: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. CONCLUSIONS: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients.

Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

“…The TeaM study recruited 376 patients undergoing 385 TM procedures to avoid mastectomy, from 50 centres in the UK and Europe between 1 September 2016 and 30 June 2017. The iBRA‐2 study recruited 2540 patients undergoing mastectomy with (1008) or without (1532) IBR from 76 centres between 1 July and 31 December 2016. Of the 1008 patients receiving IBR, 675 had 773 implant‐based reconstructions, 105 received 106 pedicled flaps and 228 patients underwent 247 free‐flap reconstructions.…”

“…TM may particularly improve outcomes for patients considered high risk (current smokers, those with high BMI) who may not be offered immediate reconstruction because of their risk profile. Reducing the risk of complications after breast cancer surgery is an important consideration as complications have been shown to result in delays to adjuvant therapy that could have an adverse impact on long‐term oncological outcomes and compromise survival.…”

“…The methods for the iBRA‐2 and TeaM prospective cohort studies have been reported previously. The two studies collected identical data items during an overlapping time interval and 37 centres participated in both studies, supporting the validity of a pooled analysis.…”

“…Primary and secondary outcomes in iBRA‐2 and TeaM were selected based on current best practice and the National Institute for Health and Care Excellence guidelines. Standardized definitions were used across both studies, allowing meaningful pooling of the data.…”

“…Before such a study can be planned, however, preliminary work is needed to explore what proportion of patients could potentially avoid mastectomy by undergoing a TM procedure and the relative safety of this approach. Two large trainee‐led prospective cohort studies have evaluated the short‐term outcomes of TM and mastectomy with and without IBR separately. A pooled analysis was undertaken in the present study to evaluate the potential for TM to avoid mastectomy, and to compare the short‐term outcomes of the different techniques.…”