The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

On Behalf Of The Ibra-2 Steering Group ,Rachel L O’Connell,Matthew Gardiner,Joanna Skillman,Nicola L P Barnes,The Breast Reconstruction Research Collaborative ,Shelley Potter,Chris Holcombe,Adam Trickey,Rajiv V Dave,Tim Rattay,Adrian Harnett

doi:10.1038/s41416-019-0438-1

Abstract

BackgroundImmediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy.MethodsConsecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored.ResultsA total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays.ConclusionsIBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients.

Highlights

Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise longterm outcomes
Breast reconstruction is associated with more complications than simple mastectomy,[5] and concerns have been raised that the increased complication rate may lead to the delay or omission of adjuvant chemotherapy or radiotherapy,[6] which may compromise oncological outcomes
Study design and participants A prospective multicentre cohort study was used to determine whether IBR influenced time to delivery of adjuvant therapy compared to mastectomy alone

Summary

Introduction

Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise longterm outcomes. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. CONCLUSIONS: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Breast reconstruction is associated with more complications than simple mastectomy,[5] and concerns have been raised that the increased complication rate may lead to the delay or omission of adjuvant chemotherapy or radiotherapy,[6] which may compromise oncological outcomes. The clinical significance of short delays is unclear, but two recent large population-based studies have shown that patients experiencing delays of more than 90 days in the delivery of chemotherapy experienced worse overall and cancerspecific survival.[7,8] a recent meta-analysis suggests a

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