Abstract
Background
Immediate breast reconstruction (IBR) using Free flaps is becoming increasingly popular.
However, these are complex surgical procedures with more complications and longer
recovery time, which can potentially delay adjuvant treatment. Our aim is to investigate
the impact of free flap IBR on the timing of adjuvant treatment.
Methods
Details of all breast cancer patients undergoing mastectomy with (study group) and
without (control group) free flap IBR, followed by adjuvant treatment between 2002
and 2007 were obtained. The time lapse between surgery and adjuvant therapy was calculated
and the causes of delay were recorded. The results were compared between the two groups
and with local and international guidelines.
Results
Twenty-seven and 139 patients were included in the study and control group, respectively.
The mean time period between surgery and commencement of adjuvant treatment for the
study group was 55 days compared with 40 days for the controls. Furthermore, significantly
less IBR patients received their adjuvant treatment within 6, 8 or 10 weeks after
surgery in comparison to the control group. Groups appeared similar however at 12-week
point. The reason for the delays was reconstruction-related surgical complications.
Conclusion
There is a significant delay in the commencement of adjuvant treatment after mastectomy
and free flap IBR in comparison to mastectomy alone patients due to reconstruction
related surgical complications. The effects of this delay on survival have not been
fully investigated yet and may be significant for at least some of the patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Effects of immediate breast reconstruction on psychological morbidity after mastectomy.Lancet. 1983; 1: 459-462
- Patients psychological and cosmetic experience after immediate breast reconstruction.Eur J Surg Oncol. 1996; 22: 262-266
- The psychological impact of immediate rather than delayed breast reconstruction.Eur J Surg Oncol. 2000; 26: 17-19
- The effect of immediate breast reconstruction on adjuvant chemotherapy.Breast. 2005; 14: 18-21
- Immediate breast reconstruction does not lead to a delay in the delivery of adjuvant chemotherapy.Eur J Surg Oncol. 2004; 30: 624-627
- National Institute for Health and Clinical Excellence (2009) – early and locally advanced breast cancer: diagnosis and treatment.([accessed December 2009])
- Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer.J Clin Oncol. 2006; 24: 4888-4894
- Immediate breast reconstruction after mastectomy increases wound complications.Arch Surg. 2004; 139: 988-991
- Does timing of adjuvant chemotherapy for early breast cancer influence survival?.J Clin Oncol. 2003; 21: 3792-3797
- Immediate breast reconstruction: why the free TRAM over the conventional TRAM flap?.Plast Reconstr Surg. 1992; 90: 255-261
- Immediate TRAM flap breast reconstruction: 128 consecutive cases.Plast Reconstr Surg. 1993; 92: 217-227
- Application of screening principles to the reconstructed breast.J Clin Oncol. 2010; 28: 173-180
- Breast cancer local recurrence after mastectomy and TRAM flap reconstruction: incidence and treatment options.Plast Reconstr Surg. 2006; 117: 1381-1386
- Breast reconstruction after mastectomy: current state of the art.NZ J Surg. 2005; 75: 454-458
- Evolution of breast cancer management in Ireland: a decade of change.BMC Surg. 2009; 9: 15
- Oncoplastic breast surgery: a global perspective on practice, availability, and training.World J Surg. 2008; 32: 2570-2577
- Postmastectomy radiotherapy: clinical practice guidelines of the American Society of clinical Oncology.J Clin Oncol. 2001; 19: 1539-1569
- Surgical guidelines for the management of breast cancer.Eur J Surg Oncol. 2009; 35: s1-s22
- Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions.Plast Reconstr Surg. 2009; 124: 737-751
- Oncoplastic breast surgery: past, present, and future directions in the United States.Plast Reconstr Surg. 2009; 124: 969-972
- Effect of timing of initiation of adjuvant chemotherapy on disease-free survival in breast cancer.Breast Cancer Res Treat. 1982; 2: 163-169
- Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors.J Clin Oncol. 2000; 18: 584-590
- Autologous tissue immediate breast reconstruction: desired but oncologically safe?.Int J Clin Pract. 2009; 63: 1642-1646
- Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapy.Am J Surg. 2002; 183: 218-221
- Delay of adjuvant chemotherapy initiation following breast cancer surgery among elderly women.Breast Cancer Res Treat. 2006; 99: 313-321
- Influence of timing of initiation of adjuvant chemotherapy over survival in breast cancer: a negative outcome study by the Spanish breast cancer research group (GEICAM).Breast Cancer Res Treat. 2007; 101: 215-223
- 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: 627-632
Article info
Publication history
Accepted:
June 7,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
