Annals of Surgical Oncology

, Volume 19, Issue 2, pp 560–566 | Cite as

A Comparison of Surgical Complications Between Immediate Breast Reconstruction and Mastectomy: The Impact on Delivery of Chemotherapy—An Analysis of 391 Procedures

  • Toni Zhong
  • Stefan O. P. Hofer
  • David R. McCready
  • Lindsay M. Jacks
  • Francis E. Cook
  • Nancy Baxter
Breast Oncology



To compare the postoperative complications after immediate breast reconstruction (IBR) versus mastectomy alone and to examine the impact on the delivery of chemotherapy.


In this prospective series, there were 391 consecutive women who underwent mastectomy (243 mastectomy alone and 148 mastectomy and IBR). The outcome measures were complications (within 3 months after surgery) and time to adjuvant chemotherapy.


Compared to the IBR group, patients in the mastectomy alone group were significantly older (P < 0.0001), smokers (P = 0.007) and less likely to have had previous radiation or lumpectomy (P < 0.0001). Overall, the complication rate was significantly greater in the IBR group than mastectomy alone (27.0% vs. 15.6%, P = 0.009). Univariate analyses revealed that mastectomy with IBR [odds ratio (OR) = 2, 95% confidence interval (CI) 1.21–2.30]; bilateral procedure (OR = 1.84, 95% CI 1.07–3.16); previous radiotherapy (OR = 2.4, 95% CI 1.29–4.47); and previous lumpectomy (OR = 1.84, 95% CI 1.11–3.03) were significant predictors of increased complications. With multivariable analysis, none of these variables were significantly associated with increased complications. 106 patients received adjuvant chemotherapy; median time from mastectomy to chemotherapy was 6.8 (0.71–15) weeks in the mastectomy alone group (n = 96) compared to 8.5 (6.3–11) weeks in the IBR group (n = 10) (P = 0.01).


Although the incidence of overall and major postoperative complications was higher after IBR than mastectomy alone, there were no significant relationships in the multivariable analysis. IBR was associated with a modest increase in time to chemotherapy that was statistically but not clinically significant.


Adjuvant Chemotherapy Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection National Comprehensive Cancer Network Breast Reconstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Elder EE, Brandberg Y, Bjorklund T, et al. Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast. 2005;14:201–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Howard MA, Polo K, Pusic AL, et al. Breast cancer local recurrence after mastectomy and TRAM flap reconstruction: incidence and treatment options. Plast Reconstr Surg. 2006;117:1381–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Murphy RX Jr, Wahhab S, Rovito PF, et al. Impact of immediate reconstruction on the local recurrence of breast cancer after mastectomy. Ann Plast Surg. 2003;50:333–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Vandeweyer E, Hertens D, Nogaret JM, Deraemaecker R. Immediate breast reconstruction with saline-filled implants: no interference with the oncologic outcome? Plast Reconstr Surg. 2001;107:1409–12.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    Cordeiro PG. Breast reconstruction after surgery for breast cancer. N Engl J Med. 2008;359:1590–601.PubMedCrossRefGoogle Scholar
  7. 7.
    Desch CE, Penberthy LT, Hillner BE, et al. A sociodemographic and economic comparison of breast reconstruction, mastectomy, and conservative surgery. Surgery. 1999;125:441–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Joslyn SA. Patterns of care for immediate and early delayed breast reconstruction following mastectomy. Plast Reconstr Surg. 2005;115:1289–96.PubMedCrossRefGoogle Scholar
  9. 9.
    Kronowitz SJ, Kuerer HM. Advances and surgical decision-making for breast reconstruction. Cancer. 2006;107:893–907.PubMedCrossRefGoogle Scholar
  10. 10.
    Morrow M, Scott SK, Menck HR, et al. Factors influencing the use of breast reconstruction postmastectomy: a National Cancer Database study. J Am Coll Surg. 2001;192:1–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Coleman RE. Current and future status of adjuvant therapy for breast cancer. Cancer. 2003;97:880–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Buzdar AU, Singletary SE, Valero V, et al. Evaluation of paclitaxel in adjuvant chemotherapy for patients with operable breast cancer: preliminary data of a prospective randomized trial. Clin Cancer Res. 2002;8:1073–9.PubMedGoogle Scholar
  13. 13.
    Alderman AK, Wei Y, Birkmeyer JD. Use of breast reconstruction after mastectomy following the Women’s Health and Cancer Rights Act. JAMA. 2006;295:387–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Rainsbury RM. Skin-sparing mastectomy. Br J Surg. 2006;93:276–81.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Mortenson MM, Schneider PD, Khatri VP, et al. Immediate breast reconstruction after mastectomy increases wound complications; however, initiation of adjuvant chemotherapy is not delayed. Arch Surg. 2004;139:988–91.PubMedCrossRefGoogle Scholar
  17. 17.
    Alderman AK, Collins ED, Schott A, et al. The impact of breast reconstruction on the delivery of chemotherapy. Cancer. 2010;116:1791–800.PubMedCrossRefGoogle Scholar
  18. 18.
    Bostwick J 3rd, Carlson GW. Reconstruction of the breast. Surg Oncol Clin N Am. 1997;6:71–89.PubMedGoogle Scholar
  19. 19.
    Thornton J, Sorokin ES. Optimal timing of breast reconstruction—an algorithm for management based on a review of the literature. Breast Dis. 2002;16:31–5.PubMedGoogle Scholar
  20. 20.
    Cold S, During M, Ewertz M, et al. Does timing of adjuvant chemotherapy influence the prognosis after early breast cancer? Results of the Danish Breast Cancer Cooperative Group (DBCG). Br J Cancer. 2005;93:627–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Lohrisch C, Paltiel C, Gelmon K, et al. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 2006;24:4888–94.PubMedCrossRefGoogle Scholar
  22. 22.
    O’Brien W, Hasselgren PO, Hummel RP, et al. Comparison of postoperative wound complications and early cancer recurrence between patients undergoing mastectomy with or without immediate breast reconstruction. Am J Surg. 1993;166:1–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Vinton AL, Traverso LW, Zehring RD. Immediate breast reconstruction following mastectomy is as safe as mastectomy alone. Arch Surg. 1990;125:1303–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Peled AW, Itakura K, Foster RD, et al. Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction. Arch Surg. 2010;145:880–5.CrossRefGoogle Scholar
  25. 25.
    Zweifel-Schlatter M, Darhouse N, Roblin P, et al. Immediate microvascular breast reconstruction after neoadjuvant chemotherapy: complication rates and effect on start of adjuvant treatment. Ann Surg Oncol. 2010;17:2945–50.PubMedCrossRefGoogle Scholar
  26. 26.
    McCarthy CM, Mehrara BJ, Riedel E, et al. Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg. 2008;121:1886–92.PubMedCrossRefGoogle Scholar
  27. 27.
    Mitchem J, Herrmann D, Margenthaler JA, Aft RL. Impact of neoadjuvant chemotherapy on rate of tissue expander/implant loss and progression to successful breast reconstruction following mastectomy. Am J Surg. 2008;196:519–22.PubMedCrossRefGoogle Scholar
  28. 28.
    Woerdeman LAE, Hage JJ, Hofland MMI, Rutgers EJT. A prospective assessment of surgical risk factors in 400 cases of skin-sparing mastectomy and immediate breast reconstruction with implants to establish selection criteria. Plast Reconstr Surg. 2007;119:455–63.PubMedCrossRefGoogle Scholar
  29. 29.
    Zhong T, Neinstein R, Massey C, et al. Intravenous fluid infusion rate in microsurgical breast reconstruction: important lessons learned from 354 free flaps. Plast Reconstr Surg. (in press).Google Scholar
  30. 30.
    Rao SS, Parikh PM, Goldstein JA, Nahabedian MY. Unilateral failures in bilateral microvascular breast reconstruction. Plast Reconstr Surg. 2010;126:17–25.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Toni Zhong
    • 1
  • Stefan O. P. Hofer
    • 1
  • David R. McCready
    • 2
  • Lindsay M. Jacks
    • 3
  • Francis E. Cook
    • 4
  • Nancy Baxter
    • 5
    • 6
  1. 1.Division of Plastic and Reconstructive Surgery, Department of Surgery, University Health NetworkUniversity of TorontoTorontoCanada
  2. 2.Department of Surgical Oncology, Department of Surgery, University Health NetworkUniversity of TorontoTorontoCanada
  3. 3.Department of Epidemiology and Biostatistics, University Health NetworkUniversity of TorontoTorontoCanada
  4. 4.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  5. 5.Departments of Surgery and Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
  6. 6.Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s HospitalTorontoCanada

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