Do modern methods of post-mastectomy immediate breast reconstruction for breast cancer delay adjuvant therapy?

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Abdul Syed
Harun Thomas
Simon Smith
Venkat Ramakrishnan


mastectomy, reconstruction, adjuvant therapy


Background and aim of the work: Modern techniques of immediate breast reconstruction after mastectomies for breast cancer gives excellent cosmetic results and improve quality of life. However, it is perceived that immediate breast reconstruction may prolong recovery and can result in complications delaying adjuvant therapy. We aim to determine if there is such delay in the United Kingdom beyond the 31 days recommended by the National Institute for Health and Care Excellence. Methods: All patients who underwent mastectomy for breast cancer from January 2009 to August 2014 and received adjuvant treatment were categorised into three groups – mastectomy, implant / expander and flap. The primary end point was the time interval from the definitive surgical procedure to the start of adjuvant therapy. Results: Of the 192 patients (64 per group) analysed, mastectomy patients were significantly older, smokers and with higher nodal status (p<0.05). The groups were comparable with respect to other clinicopathological factors (p>0.05). Six patients from implant group and one patient from flap group started their adjuvant therapy within 31 days. The mean duration of adjuvant therapy was 63.2 days (33-202) in mastectomy group, 52.82 days (26-136) in implant group and 50.61days (29-89 days) after flap procedures (p=0.004). Conclusions: Our study shows a delay in initiating adjuvant therapy in keeping with published literature. The reasons could be multifactorial including delay in service provision. This delay is statistically significant in the mastectomy-alone patients, perhaps because they were older and smokers. Treatment pathways and multidisciplinary clinics will circumvent these concerns.



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Cancer Research UK, Cancer Statistics Reports for the UK 2015
Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet 1983; 320: 459-462.
Rosenqvist S, Sandelin K, Wickman M. Patients’ psychological and cosmetic experience after immediate breast reconstruction. Eur J Surg Oncol 1996; 22: 262- 6.
D’Souza N, Darmanin G, Fedorowicz Z. Immediate versus delayed reconstruction following surgery for breast cancer. Cochrane Database of Systematic Reviews 2011; 7. Art. No.: CD008674. DOI: 10.1002/14651858.CD008674.pub2.
Atisha D, Alderman AK, Lowery JC, et al. Prospective analysis of long-term psychosocial outcomes in breast reconstruction: 2-year postoperative results from the Michigan Breast Reconstruction Outcomes Study. Ann Surg 2008; 247: 1019-28.
Drucker-Zertuche M, Robles-Vidal C. A 7 year experience with immediate breast reconstruction after skin sparing mastectomy for cancer. European J Surg Oncol 2007; 33(2): 140-6.
Rainsbury RM. Skin-sparing mastectomy. Br J Surg 2006; 93: 276-81.
Giacalone PL, Rathat G, Daures JP, Benos P, Azria D, Rouleau C. New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and aesthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study. Breast Cancer Res Treat 2010; 122(2): 439-51. [PUBMED: 20502959]
Langstein HN, Cheng MH, Singletary SE, Robb GL, Hoy E, Smith TL, et al. Breast cancer recurrence after immediate reconstruction: patterns and significance. Plast Reconstr Surg 2003; 111(2): 712-20.
Newman LA, Kuerer HM, Hunt KK, Ames FC, Ross MI, Theriault R, et al. Feasibility of immediate breast reconstruction for locally advanced breast cancer. Ann Surg Oncol 1999; 6(7): 671-5.
Vaughan A, et al. Patterns of local breast cancer recurrence after skin-sparing mastectomy and immediate breast reconstruction. Am J Surg 2007; 194: 438-43.
Patani N, Devalia H, Anderson A, Mokbel K. Oncological safety and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction. Surg Oncol 2008; 17: 97-105.
National Mastectomy and breast reconstruction audit 2011.
Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 365(9472): 1687-717.
EBCTCG (Early Breast Cancer Trialists’ Collaborative Group). Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 2014; 383: 2127-35.
National Institute for Clinical Excellence. CG80- Early and locally advanced breast cancer: Diagnosis and treatment.
Desch CE, McNiff KK, Schneider EC, et al. American Society of Clinical Oncology/National Comprehensive Cancer Network quality measures. J Clin Oncol 2008; 26(21): 3631-7.
Dindo D,Demartines N,Clavien PA. Classification of Surgical Complications- A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg 2004; 240: 205-13.
Hamahata A, Kubo K, Takei H, Saitou T, Hayashi Y, Matsumoto H, Nagai S, Inoue K, Kurosumi M, Yamaki T, Sakurai H. Impact of immediate breast reconstruction on postoperative adjuvant chemotherapy: a single centre study Breast Cancer 2015; 22(3): 287-91. DOI 10.1007/s12282-013-0480-4
R Core Team (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL
John Fox (2003). Effect Displays in R for Generalised Linear Models. Journal of Statistical Software, 8(15), 1-27. URL
John Fox, Jangman Hong (2009). Effect Displays in R for Multinomial and Proportional-Odds Logit Models: Extensions to the effects Package. Journal of Statistical Software, 32(1), 1-24. URL
Bob Wheeler (2010). lmPerm: Permutation tests for linear models. R package version 1.1-2.
Angelo Canty and Brian Ripley (2014). boot: Bootstrap R (S-Plus) Functions. R package version 1.3-13.
Davison AC, Hinkley DV. (1997) Bootstrap Methods and Their Applications. Cambridge University Press, Cambridge. ISBN 0-521-57391-2
Dunn OJ. Multiple Comparisons among Means, JAMA 1961; 56: 52-64.
Al-Ghazal SK, Fallowfield L, Blamey RW. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 2000; 26(1): 17-9.
Yeh KA, Lyle G, Wei JP, Sherry R. Immediate breast reconstruction in breast cancer: morbidity and outcome. Am Surg 1998; 64: 1195-9.
Alderman AK, Wilkins EG, Kim HM, Lowery JC. Complications in post mastectomy breast reconstruction: two-year results of the Michigan breast reconstruction outcome study. Plast Reconstr Surg 2002; 109: 2265-74.
Ringberg A, Tengrup I, Aspegren K, Palmer B. Immediate breast reconstruction after mastectomy for cancer. Eur J Surg Oncol 1999; 25: 470-6.
Caffo O, Cazzolli D, Scalet A, et al. Concurrent adjuvant chemotherapy and immediate breast reconstruction with skin expanders after mastectomy for breast cancer. Breast Cancer Res Treat 2000; 60: 267-75.
Vandeweyer E, Deramaecker R, Nogaret JM, Hertens D. Immediate breast reconstruction with implants and adjuvant chemotherapy: a good option? Acta Chir Belg 2003; 103: 98-101.
Zhong T, Hofer SO, McCready DR, Jacks LM, Cook FE, BaxterN. A comparison of surgical complications between immediate breast reconstruction and mastectomy: the impact on delivery of chemotherapy—an analysis of 391 procedures. Ann Surg Oncol 2011; 19: 560-6.
Chang RJ, Kirkpatrick K, De Boer RH, Bruce Mann G. Does immediate breast reconstruction compromise the delivery of adjuvant chemotherapy? Breast 2013; 22(1): 64-9.
Allweis TM, Boisvert ME, Otero SE, et al. Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapy. Am J Surg 2002; 183: 218-21.
Mortenson MM, Schneider PD, Khatri VP, Stevenson TR, Whetzel TP, Sommerhaug EJ, Goodnight JE Jr, Bold RJ. Immediate breast reconstruction after mastectomy increases wound complications: however, initiation of adjuvant chemotherapy is not delayed. Arch Surg 2004; 139: 988-91.
Shikhman, Dinh, O’Connor, Larkin. Time to treatment: Influence of immediate breast reconstruction on postoperative chemotherapy. Ann Surg Oncol 2014; 21: 110.
Alderman AK, Collins ED, Schott A, Hughes ME, Ottesen RA,Theriault RL, Wong YN, Weeks JC, Niland JC, Edge SB. The impact of breast reconstruction on the delivery of chemotherapy. Cancer 2010; 116: 1791-800.
Taylor CW, Kumar S. The effect of immediate breast reconstruction on adjuvant chemotherapy. Breast 2005; 14: 18-21.