Do Mastectomy Skin Complications Delay Adjuvant Therapy after Autologous Breast Reconstruction?

Abstract

INTRODUCTION: Autologous breast reconstruction (ABR) is an important treatment modality to minimize postmastectomy deformity and restore body image in patients with breast cancer. However, it remains unclear what effect complications after ABR have on initiation of adjuvant treatments. This is significant because delays in adjuvant therapy are associated with poorer oncologic outcomes.1 Here, we examined risk factors for developing mastectomy skin complications, and how incidence of these complications affected initiation of adjuvant therapy. METHODS: A retrospective chart review was conducted of all patients undergoing ABR between 2007 and 2018. Patients were included if they underwent abdominally-based ABR and were treated with either adjuvant chemotherapy or radiation after mastectomy, and had at least 6 months of follow-up. Data were abstracted from the medical records, including demographics, oncologic information, operative details, mastectomy skin complications, and time to initiation of adjuvant therapy. Categorical and continuous variables were compared using χ2 and t-tests, respectively. RESULTS: In total, 582 patients met inclusion criteria, of which 243 (42%) experienced a complication in their mastectomy skin flap. Patients who experienced a mastectomy skin complication had a significantly higher BMI than patients who did not (30.0 versus 27.2 kg/m2; P < 0.001). Similarly, patients with diabetes or hypertension were significantly more likely to develop a mastectomy skin complication (both P < 0.05). Active smoking also significantly increased risk of mastectomy skin complications, with 13% of patients with complications admitting to nicotine use compared with 5.3% of patients who did not suffer a complication (P = 0.001). Neither mastectomy nor flap type predicted the incidence of mastectomy skin complication (both P > 0.05). Overall, patients began adjuvant chemotherapy and radiation on average 62 days and 121 days after reconstruction, respectively. Patients who experienced a mastectomy skin complication had significant delays in initiation of adjuvant radiation, on average beginning therapy 134 days after reconstruction compared with 113 days for patients without a mastectomy skin flap complication (P = 0.004). On the other hand, incidence of mastectomy skin complication did not significantly affect the initiation date of adjuvant chemotherapy (P = 0.18). When considering oncologic status, cancer stage and primary tumor stage significantly impacted the timing of initiation of adjuvant chemotherapy (both P < 0.05). Primary tumor stage also significantly impacted timing until initiation of adjuvant radiation (P = 0.002). CONCLUSIONS: Mastectomy skin complications after autologous breast reconstruction cause significant delays in the initiation of adjuvant radiation, which can be detrimental for patients with high grade cancers. Additionally, patients with comorbidities like elevated BMI, diabetes, hypertension, and active smoking were at significantly higher risk of developing mastectomy skin complications. Plastic surgeons in concert with high risk patients should try to address modifiable risk factors before reconstruction to reduce the risk of mastectomy skin complications and thus delaying adjuvant cancer care, and individuals with high grade cancers may consider delayed reconstruction to avoid postponement of adjuvant therapy. REFERENCE: 1. Flores-Balcázar CH, Flores-Luna L, Villarreal-Garza C, et al. Impact of delayed adjuvant radiotherapy in the survival of women with breast cancer. Cureus. 2018 Jul 30;10(7):e3071.