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.
Similar content being viewed by others
References
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.
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.
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.
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.
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.
Cordeiro PG. Breast reconstruction after surgery for breast cancer. N Engl J Med. 2008;359:1590–601.
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.
Joslyn SA. Patterns of care for immediate and early delayed breast reconstruction following mastectomy. Plast Reconstr Surg. 2005;115:1289–96.
Kronowitz SJ, Kuerer HM. Advances and surgical decision-making for breast reconstruction. Cancer. 2006;107:893–907.
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.
Coleman RE. Current and future status of adjuvant therapy for breast cancer. Cancer. 2003;97:880–6.
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.
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.
Rainsbury RM. Skin-sparing mastectomy. Br J Surg. 2006;93:276–81.
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, et al. Immediate breast reconstruction after mastectomy increases wound complications; however, initiation of adjuvant chemotherapy is not delayed. Arch Surg. 2004;139:988–91.
Alderman AK, Collins ED, Schott A, et al. The impact of breast reconstruction on the delivery of chemotherapy. Cancer. 2010;116:1791–800.
Bostwick J 3rd, Carlson GW. Reconstruction of the breast. Surg Oncol Clin N Am. 1997;6:71–89.
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.
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.
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.
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.
Vinton AL, Traverso LW, Zehring RD. Immediate breast reconstruction following mastectomy is as safe as mastectomy alone. Arch Surg. 1990;125:1303–7.
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.
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.
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.
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.
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.
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).
Rao SS, Parikh PM, Goldstein JA, Nahabedian MY. Unilateral failures in bilateral microvascular breast reconstruction. Plast Reconstr Surg. 2010;126:17–25.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhong, T., Hofer, S.O.P., McCready, D.R. et al. 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 19, 560–566 (2012). https://doi.org/10.1245/s10434-011-1950-6
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-011-1950-6