Does immediate breast reconstruction delay adjuvant therapy?

  • O'Connell RL & al.
  • Br J Cancer
  • 29 Mar 2019

  • curated by Dawn O'Shea
  • UK Medical News
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Immediate breast reconstruction (IBR) does not result in clinically significant delays in the delivery of adjuvant therapy compared to mastectomy alone, according to findings from the iBRA-2 (immediate breast reconstruction and adjuvant therapy audit) study.

The study recruited 2,540 consecutive women undergoing mastectomy ± IBR for breast cancer at one of 76 UK centres between July and December 2016. Of these, 1008 (39.7%) underwent IBR (implant-only [n=675]; pedicled flaps [n=105] and free-flaps [n=228]).

The results, published in the British Journal of Cancer, show no clinically significant differences in time to adjuvant therapy between patient groups but major complications, irrespective of surgery, were significantly associated with treatment delays.

Age, BMI, comorbidities, smoking and axillary node clearance were strongly associated with post-operative complications in multivariate analysis, as were bilateral surgery and free-flap reconstruction. Implant-based (adjusted OR [aOR], 4.34; 95% CI, 2.35-7.99) and free-flap reconstruction (aOR, 4.88; 95% CI, 2.63-9.04) were the strongest predictors for major complications.

However, the absolute differences in median time to adjuvant treatment across the groups were small (52; interquartile range [IQR], 41-66) days for mastectomy only vs 57 (IQR, 46-72) days for free-flap reconstruction.

“Although free-flap reconstruction was associated with a longer time to adjuvant therapy than other procedure types, the absolute differences in time to treatment between the surgical groups is small. This study therefore suggests that IBR does not result in clinically significant delays in the delivery of adjuvant therapy compared to mastectomy alone,” the authors concluded.

They advised that that strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients.