Does Immediate Breast Reconstruction after Mastectomy affect the Initiation of Adjuvant Chemotherapy?

Abstract

PurposeThe frequency of immediate breast reconstruction (IBR) is increasing, and the types of reconstruction used are diverse. Adjuvant chemotherapy is a life-saving intervention in selected high-risk breast cancer patients. The aim of our study was to determine how IBR and type of reconstruction affect the timing of the initiation of chemotherapy.MethodsWe obtained data from female breast cancer patients treated by mastectomy with IBR (IBR group) and without IBR (mastectomy only group) who received adjuvant chemotherapy between January 1, 2008, and December 31, 2010. We retrospectively collected data including patient characteristics, disease characteristics, treatment details, and treatment outcomes from our institutional electronic patient database and medical treatment records. The reconstruction types were categorized as deep inferior epigastric perforator (DIEP) flap, latissimus dorsi (LD) flap and tissue expander/implant (TEI).ResultsIn total, 595 patients were included in this study. Of these patients, 43 underwent mastectomy with IBR (IBR group) and 552 patients did not undergo reconstruction (mastectomy only group). There was significant difference in the timing of the initiation of chemotherapy between the two groups (p<0.0001). There were no cases of delays of more than 12 weeks. In the IBR group, 20 patients received TEI, 9 patients were treated by the insertion DIEP flaps, and 14 patients were treated by LD flaps. There were no significant differences in the timing of chemotherapy according to the type of reconstruction (p=0.095).ConclusionIBR delays the initiation of chemotherapy, but does not lead to omission or significant clinical delay in chemotherapy. Further, the type of reconstruction does not affect the timing of chemotherapy.

The effect of immediate breast reconstruction on the timing of adjuvant chemotherapy: a systematic review

“…Different cut-off points were chosen: two studies chose 8 weeks, three studies chose 12 weeks, and one study reported the number of patients per 10 days. No statistically significant differences for this comparison were found for these cut-off points [ 7 , 16 , 18 , 20 , 22 , 26 ]. In patients with IBR, the few delays beyond 12 weeks after surgery were not related to the type of surgery, but due to social reasons and delayed diagnostic test results [ 7 , 20 ].…”

“…Due to lack of pertinent information, the legitimacy to do a meta-analysis was doubted. Moreover, an I 2 of 98 % was observed, after pooling the studies that used the same definition for time to chemotherapy and reported mean values and standard deviations [ 7 , 17 , 20 , 22 , 23 ], indicating a high statistical heterogeneity. We found no obvious explanation for this high statistical heterogeneity.…”

“…In the twelve studies that measured TTC from surgery, it varied between 29 and 61 days in the IBR groups and between 21 and 60 days in the patient groups that received mastectomy only. Differences in TTC between the IBR groups and the mastectomy only groups varied widely from a 12.6 days reduction in average TTC after IBR to a delay of 11.9 days in average TTC after IBR [ 7 , 16 – 20 , 22 – 26 , 28 ]. One study found a significantly shorter TTC after IBR [ 17 ], three studies found a statistically significant delay following IBR [ 7 , 22 , 24 ], six studies found no statistically significant difference in TTC between IBR and mastectomy only [ 18 – 20 , 23 , 25 , 28 ], and two studies did not perform a statistical test for the comparison [ 16 , 26 ].…”

Factors Associated With Delays in Chemotherapy Initiation Among Patients With Breast Cancer at a Comprehensive Cancer Center

“…21 Multiple factors, including age, disease-specific characteristics, type of surgical procedure, and additional testing have been found to influence this trend. [21][22][23][24][25][26][27] In an era of increasing use of Oncotype DX to assist with chemotherapy treatment decisions, an aging population with comorbidities needing to be addressed, and the more prevalent use of MIR, it is not surprising that wait times to adjuvant therapy continue to increase.…”

Second primary breast cancer in BRCA1 and BRCA2 mutation carriers: 10-year cumulative incidence in the Breast Cancer Family Registry

“…Despite the high risk of developing a subsequent breast cancer (as high as 3% yearly rate in some reports [2]), no survival benefit has been observed with risk-reducing contralateral mastectomy [7], highlighting the need to better select women for this treatment. Risk-reducing surgery, which usually includes immediate breast reconstruction, may delay therapeutic surgery and subsequent adjuvant treatment [8], as complication rates are higher [9] and the recovery time is increased with bilateral surgery. Delay in treatment (both surgery and adjuvant treatment) may impede the chance of survival from the present cancer [10].…”