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

Abstract

Purpose

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

Methods

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.

Results

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).

Conclusions

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.

Keywords

Adjuvant Chemotherapy Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection National Comprehensive Cancer Network Breast Reconstruction 

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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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