Impact Of Immediate Breast Reconstruction Research Articles

An observational study of the impact of immediate breast reconstruction on perioperative inflammatory cytokines.

Perioperative inflammatory cytokines may be related to cancer proliferation, although few studies have investigated this issue in patients undergoing breast reconstruction surgery. We conducted a prospective study of patients scheduled for mastectomy only, mastectomy plus deep inferior epigastric perforator flap reconstruction (DIEP), or mastectomy plus tissue expander reconstruction (TE), with or without axial dissection (Ax), for primary breast cancer. Blood samples were collected for analysis of serum IL-6 and VEGF preoperatively, then within 24h postoperatively (POD 1), and 4-6days postoperatively (POD 4-6). We investigated the difference in serum cytokine levels over time for each surgical procedure and the difference in serum cytokine levels among the procedures at the three measurement time points. There were 120 patients included in the final analysis. Serum IL-6 was significantly higher than the preoperative level on POD 1 in patients who underwent mastectomy only, DIEP, or TE and Ax (+), with higher values persisting on POD 4-6 except in those who underwent DIEP. IL-6 was significantly higher after DIEP than after mastectomy only on POD 1, but no differences were observed at POD 4-6. VEGF did not differ significantly among the surgical procedures at any time. The increase in IL-6 was short term and immediate breast reconstruction is considered a safe procedure.

Association between Immediate Breast Reconstruction and the Development of Breast Cancer-Related Lymphedema.

With the increasing number of patients undergoing immediate breast reconstruction after mastectomy, the impact of immediate breast reconstruction on the risk of breast cancer-related lymphedema has become an emerging area of interest. This study aimed to identify the association between immediate breast reconstruction and postoperative lymphedema. A retrospective cohort study was conducted from 2006 to 2016 with 5900 consecutive patients who underwent mastectomy for primary breast cancer with or without immediate breast reconstruction. After excluding patients with synchronous contralateral breast cancer, lymphedema before mastectomy, history of procedures performed in the axillary region, and follow-up data of less than 1 year, the cumulative incidence of lymphedema after immediate breast reconstruction and after no reconstruction was calculated and compared using multivariate Cox regression analysis. Overall, 5497 patients (mean age, 51.7 years) were included, and 630 developed lymphedema. The 5-year cumulative incidence rate of lymphedema was significantly reduced in patients who underwent immediate breast reconstruction versus control patients (9.6% versus 12.2%; P = 0.02). In the multivariate analysis, immediate breast reconstruction status (hazard ratio, 0.75; 95% confidence interval, 0.56 to 0.99; P = 0.042) was an independent predictor for lymphedema. Similar significant associations were observed in the subgroup analyses of patients with a body mass index less than 30 kg/m2 (P = 0.024), in those with fewer than 10 dissected lymph nodes (P = 0.042), or in those with adjuvant radiotherapy (P = 0.048). Immediate breast reconstruction was associated with a reduced risk of lymphedema. These results may be used for predicting the development of lymphedema following breast reconstruction. Risk, II.

Immediate breast reconstruction has no impact on the oncologic outcomes of patients treated with post-mastectomy radiation therapy: a comparative analysis based on propensity score matching.

To investigate the impact of immediate breast reconstruction (iBR) on patients treated with post-mastectomy radiation therapy (PMRT) using propensity score matching (PSM). After a retrospective review of patients treated with PMRT between 2008 and 2017, we included 153 patients who underwent iBR and 872 patients who did not undergo iBR. Among the 153 patients who underwent iBR, 34 received one-stage iBR with autologous tissue and 119 received two-stage iBR. Conventional fractionated PMRT with a total dose of 50-50.4Gy in 25-28 fractions was performed in all patients. Propensity scores were calculated via logistic regression. Patients who underwent iBR were younger, had early stage disease, and had more frequent hormone receptor-positive tumor than those who did not undergo iBR. After PSM, 127 patients from each group with well-balanced characteristics were selected. With a median follow-up of 67.5months, iBR led to better 6-year disease-free survival rates compared to no iBR before PSM (84.8% vs. 71.4%, p = 0.003); after PSM, there was no significant difference (84.8% vs. 75.5%, p = 0.130). On multivariable analysis in the matched cohort, iBR was not associated with inferior disease-free survival (hazard ratio, 0.67; p = 0.175). In the sensitivity analysis, iBR was not associated with a lower disease-free survival across all prognostic groups. The 5-year cumulative incidence of iBR failure was 15.0%. In patients with adverse pathologic factors planning to receive PMRT, iBR did not compromise oncologic outcomes. In addition, iBR can be considered in patients treated with PMRT with several clinicopathologic risk factors.

Effect of Immediate Breast Reconstruction after Standardized Breast Cancer Surgery on the Quality of Life of Patients: A Prospective Multicenter Study.

Objective To investigate the impact of immediate breast reconstruction (IBR) after standardized breast cancer (BC) surgery on the quality of life of patients. Methods A total of 878 BC patients were included, who were diagnosed and treated in the breast surgery department between January 2016 and December 2018. The patient underwent immediate postoperative breast reconstruction surgery. Subsequently, safety, efficacy, and postoperative morphology were scored and evaluated for the comprehensive analysis of the clinical therapeutic effects. Results With longer postoperative time, a lower proportion of the follow-up population experienced limb edema, capsular contracture, infection, calcifications around the prosthesis, prosthesis dislocation, delayed wound healing, chronic lymphadenopathy, pain, and prosthesis rupture, indicating a high safety. And the follow-up patients' breast appearance and shape largely returned to normal at 12 months postoperatively. Additionally, patients with 3 and 6 months of follow-up had a higher quality of life and better aesthetic breast reconstruction outcomes compared to the perioperative period. Conclusion The implementation of standardized IBR after breast cancer improves the quality of life of patients after surgery with fewer complications and a good safety profile.

The impact of axillary node surgery on outcomes following immediate breast reconstruction.

Immediate breast reconstruction (IBR) has become the most common method for postmastectomy reconstruction. Axillary lymph node dissection is performed for the staging of patients, but the impact of IBR with nodal surgery on postoperative complications remains elusive. The present study aims to investigate the impact of concomitant axillary lymph node surgery on postoperative complications. We conducted a retrospective study of patients who underwent IBR from 2000 to 2014. We recorded and analyzed patient data to determine the association between nodal surgery and postsurgical complications. Univariate and multivariate analyses were utilized to elucidate the risk of a complication given nodal surgery, sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND), and type of incision for nodal access. A total of 986 breast reconstructions were included for analysis. Overall incidence of postoperative complications per breast that received nodal surgery was 35.9% (n=230/642), compared to 25.6% (n=88/344) in breasts that did not have concomitant nodal surgery (P=.001). Nodal surgery was found to increase risk of all complications with an odds ratio of 1.62 (P=.001). Moreover, complications were significantly higher in patients whose nodes were accessed via mastectomy incision (39.4%) when compared to a separate incision (33.5%). Multivariate analysis showed that nodal sampling through the mastectomy incision is a significant risk factor for seroma, with an odds ratio of 3.60 (P=.002). We did not observe differences in breast complications in patients who underwent SLNB vs ALND. These factors should be taken into account in the approach to breast reconstruction during lymphadenectomy.

Quality of Life and Emotional Impact after Immediate Breast Reconstruction

Background: Mastectomy is the main method of treating breast cancer and carries a mutilating stigma. Breast reconstruction restores body aesthetics, influencing psychosocial aspects and quality of life. Thus, the aim of the study was to analyze interpersonal and emotional relationships after immediate breast reconstruction. Methods: A qualitative, descriptive and prospective study, was performed through the application of a quality life questionnaire – Breast Evaluation Questionnaire (BEQ 55) in patients who had immediate breast reconstruction, between 2010 to 2019. Results: From the 89 (n=89) women registered in the clinic’s database during the study period, 15 (n=15) of them agreed to participate. The average age was 46 years. Physical domain showed high scores, regarding intimate and sexual activities, professional and work activities, as well as social and recreation activities. Patient’s comfort in front of men were progressive smaller regarding the body dressed, in a swimsuit and naked. The same pattern was observed intimate women and with health professionals. Considering sexual domain scores showed that the more covered, the greater the satisfaction, with an improvement regarding the breasts (73.3%) when compared to the whole body (60.0%). The same pattern was observed regarding the patients’ comfort when being alone, revealing an improvement in the valorization of the breasts in relation to the whole body in the sense of self-image. Conclusion: This study allowed a better understanding of the impact of immediate breast reconstruction showing that this experience can be less traumatic and gradually overcome if there is support from family and health professionals.

Abstract P6-14-08: Impact of immediate breast reconstruction after mastectomy on the short and long-term outcome of patients receiving neoadjuvant chemotherapy

Abstract Background and Purpose In breast cancer patients receiving neoadjuvant chemotherapy (NAC), immediate breast reconstruction (IBR) is controversial. We retrospectively investigated whether IBR after mastectomy influenced the short and long-term outcome of patients receiving NAC. Patients and Methods Between April 2007 and December 2017, 525 breast cancer patients received NAC at our hospital of which 186 patients underwent total mastectomy alone, 55 underwent total mastectomy followed by IBR, and 284 underwent breast conserving surgery (BCS). Patients receiving IBR were compared to patients who did not receive IBR. The NAC regimen was 4 cycles of epirubicin, 5-fluorouracil and cyclophosphamide followed by 4 cycles of docetaxel. Decision making for post mastectomy radiotherapy (PMRT) followed national comprehensive cancer network guidelines. PMRT is not contraindication for patients receiving IBR, however risk such as capsular contracture was informed to patients. Tissue expander was replaced to silicon breast implant within two to three months, and radiotherapy started within 4 to 6 weeks after surgery. In other surgical-procedure, such as direct-to-implant breast reconstruction, BCS or mastectomy alone, radiotherapy started 6-8 weeks later. Post-mastectomy radiation was applied equally with the same selection criteria to both groups. Results Patients in the IBR and BCS groups were on average younger than patients in the mastectomy alone group (p<0.0001). In patients who underwent IBR, 29% of those with autograft and 47% of those with silicone breast implant were received radiotherapy. After a median of 76.4 month, 2 patients (4.2%) in the IBR group, 13 patients (4.5%) in the BCS group and 17 patients (9.1%) showed locoregional recurrences. Five-year locoregional recurrence-free survival was 96.1% in the IBR group, 96.8% in the BCS group and 90.1% in the mastectomy alone group (p= 0.032). Five-year distant disease-free survival was 92.9 % in the IBR group, 93.9% in the BCS group and 85.3 % in the mastectomy alone group (p= 0.0008). Five-year overall survival was 98.0 % in the IBR group, 98.4% in the BCS group and 92.3 % in the mastectomy alone group (p= 0.0004). Multivariate analysis showed that IBR was not associated with worse prognosis. Transverse rectus abdominis muscle flap necrosis was seen in one patient. Any breast implant or tissue expander related complications including infection and capsular contracture were not encountered. Conclusions IBR after total mastectomy can be performed safely and was not associated with worse prognosis in patients receiving NAC and therefore IBR may be the preferred strategy in select cases. Citation Format: Hiroko Nogi, Makiko Kamio, Takashi Kazama, Naoko Shimada, Takayuki Ishigaki, Hisashi Shioya, Yasuo Toriumi, Eijiro Nagasaki, Hiroshi Takeyama. Impact of immediate breast reconstruction after mastectomy on the short and long-term outcome of patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-08.

Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy

BackgroundInitiation of adjuvant chemotherapy within 6–12 weeks after mastectomy is recommended by guidelines. The aim of this population‐based study was to investigate whether immediate breast reconstruction (IBR) after mastectomy reduces the likelihood of timely initiation of adjuvant chemotherapy.MethodsAll patients with breast cancer who had undergone mastectomy and adjuvant chemotherapy between 2012 and 2016 in the Netherlands were identified. Time from surgery to adjuvant chemotherapy was categorized as within 6 weeks or after more than 6 weeks, within 9 weeks or after more than 9 weeks, and within 12 weeks or after more than 12 weeks. The impact of IBR on the initiation of adjuvant chemotherapy for these three scenarios was estimated using propensity score matching to adjust for treatment by indication bias.ResultsA total of 6300 patients had undergone primary mastectomy and adjuvant chemotherapy, of whom 1700 (27·0 per cent) had received IBR. Multivariable analysis revealed that IBR reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (odds ratio (OR) 0·76, 95 per cent c.i. 0·66 to 0·87) and 9 weeks (0·69, 0·54 to 0·87), but not within 12 weeks (OR 0·75, 0·48 to 1·17). Following propensity score matching, IBR only reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (OR 0·95, 0·90 to 0·99), but not within 9 weeks (OR 0·97, 0·95 to 1·00) or 12 weeks (OR 1·00, 0·99 to 1·01).ConclusionPostmastectomy IBR marginally reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks, but not within 9 or 12 weeks. Thus, IBR is not contraindicated in patients who need adjuvant chemotherapy after mastectomy.

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

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.

Abstract P4-13-16: Impact of immediate breast reconstruction after mastectomy on the outcome of patients receiving neoadjuvant chemotherapy

Abstract Background and purpose In breast cancer patients receiving neoadjuvant chemotherapy (NAC), immediate breast reconstruction (IBR) is controversial. IBR might favor recurrences and metastases due to delayed adjuvant radiation therapy. We retrospectively investigated whether IBR after mastectomy influenced the outcome of patients receiving neoadjuvant chemotherapy. Patients and methods Between 2006 and 2016, 243 breast cancer patients received total mastectomy after NAC, 48 of whom underwent IBR. Patients receiving IBR (IBR group) were compared to patients who did not receive IBR (no-IBR group) over a prolonged median follow-up time (72.3 moths). The regimen was 4 cycles of epirubicin (100 or 75 mg/m2), 5-fluorouracil (500 mg/m2), and cyclophosphamide (500 mg/m2) followed by 4 cycles of docetaxel (75 mg/m2). Post-mastectomy radiation was applied in cases treated by IBR following the same selection criteria as for standard mastectomy regardless of the reconstruction approach. Results Patients in the IBR group were on average younger than patients in no-IBR group (p<0.001). The percentage of patients with clinical T1/2 tumor was 81.2% in the IBR group and 58.4% in no-IBR group (p=0.0042). 2 patients (4.2%) in the IBR group and 9 patients (4.6%) in no-IBR group showed the locoregional recurrences. 2 patients (4.2%) in the IBR group and 20 patients (10.3%) showed distant metastases. There were no significant differences. Conclusions IBR after total mastectomy was not associated with worse rate of locoregional recurrences in patients receiving NAC. Citation Format: Nogi H, Tomita S, Kamio M, Shioya H, Toriumi Y, Takeyama H. Impact of immediate breast reconstruction after mastectomy on the outcome of patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-16.

Impact of immediate breast reconstruction on the onset of adjuvant chemotherapy and on the postoperative complications

Objective: To explore the impact of immediate breast reconstruction on the onset of adjuvant chemotherapy and on the postoperative complications. Methods: We retrospectively analyzed the clinical data from female breast cancer patients treated by either modified radical mastectomy with immediate breast reconstruction(IBR) ( n=108) or modified radical mastectomy alone(n=115), followed by adjuvant chemotherapy at our department between January 2011 and December 2012. Results: There was no significant difference in the overall complication rates between the IBR group and modified radical mastectomy group (49.1% vs. 52.2%, P=0.87). However, more secondary surgery was applied in the IBR group than the modified radical mastectomy group (13.0% vs. 1.7%, P=0.001). However, the incidence of hematoma in the modified radical mastectomy group was significantly higher than the IBR group (17.4% vs. 4.6%, P=0.003). There was a significant difference in the onset of adjuvant chemotherapy between the IBR group and modified radical mastectomy group (21 days vs. 11days, P<0.001). Conclusions: Immediate breast reconstruction has no significant impact on the overall complication rate, but increases the incidence of secondary surgery, especially after the initiation of chemotherapy. In addition, it slightly delays adjuvant chemotherapy in the patients.

The impact of immediate breast reconstruction after mastectomy on time to first adjuvant treatment in women with breast cancer in a community setting

BackgroundThe impact of immediate breast reconstruction on the time to first adjuvant therapy is controversial. MethodsRetrospective study design comparing time to first treatment in women undergoing mastectomy with and without immediate reconstruction in a community cancer center. ResultsSeventy-six cases fit inclusion criteria of which 44 (58%) underwent mastectomy with immediate reconstruction. Women undergoing immediate reconstruction were younger, had more bilateral mastectomies and had fewer prior breast procedures. The median time to first adjuvant therapy was longer in the immediate reconstruction group [80.5days (36–343) versus 53.5 days (18–96), p = 0.003]. Fifteen of 44 patients had the start of adjuvant treatment over 90 days after resection, 14 of whom (93%) had immediate reconstruction versus 1 (7%) who did not (p = 0.01). ConclusionIn this study immediate breast reconstruction was associated with a longer time to first adjuvant treatment, with adjuvant therapies being more likely delayed over 90 days.

The iBRA-2 (immediate breast reconstruction and adjuvant therapy audit) study: protocol for a prospective national multicentre cohort study to evaluate the impact of immediate breast reconstruction on the delivery of adjuvant therapy

IntroductionImmediate breast reconstruction (IBR) is routinely offered to improve quality of life for women with breast cancer requiring a mastectomy, but there are concerns that more complex surgery may delay...

Impact of immediate breast reconstruction on postoperative adjuvant chemotherapy: a single center study

Various studies have indicated a worldwide increase in the number of immediate breast reconstruction surgeries. However, breast reconstruction should not delay or prevent postoperative cancer therapeutics such as adjuvant chemotherapy and radiotherapy. In response to these developments, our team researched the impact of immediate breast reconstruction on postoperative adjuvant chemotherapy. From April 2006 to March 2011, 116 patients at Saitama Cancer Center underwent postoperative adjuvant chemotherapy following mastectomy with or without immediate breast reconstruction. Fifty patients received postoperative adjuvant chemotherapy following mastectomy with immediate breast reconstruction (IBR group), and 66 patients received the same treatment but without immediate breast reconstruction (non-IBR group). The outcomes were studied retrospectively by chart review. Patients' average age, body mass index, postoperative complication rate, and days to adjuvant chemotherapy were calculated. Mean age and body mass index of patients were 47.0±9.0years, 22.2±3.0kg/m(2) and 55.5±10.1years, 23.0±3.6kg/m(2) in IBR group and non-IBR group, respectively. Postoperative complication rate was 10.0% in IBR group and 6.1% in non-IBR group. Days to adjuvant chemotherapy was 61.0±10.5days in IBR group and 58.0±12.3days in non-IBR group. Although complication rate and days to adjuvant chemotherapy were slightly increased in IBR group, the delay was not critical to the initiation of adjuvant chemotherapy in these patient groups.

The impact of immediate breast reconstruction on post-mastectomy lymphedema in patients undergoing modified radical mastectomy

The aim of this study was to assess the impact of immediate breast reconstruction (IBR) with autologous tissue on the development of post-mastectomy lymphedema in patients undergoing modified radical mastectomy (MRM). A retrospective chart review was performed for early-stage breast cancer patients who underwent MRM between January 2001 and December 2009. Patients were categorized into two groups based on whether or not they underwent IBR. The incidence of lymphedema was assessed and compared. A total of 712 patients underwent MRM, which included 117 patients undergoing IRB. There were no significant differences between two groups except for a lower body mass index in the reconstruction group. Comparing the incidence of lymphedema using multivariate logistic regression analysis, the reconstruction group had a significantly lower incidence of lymphedema (p-value = 0.023). Breast cancer patients who underwent MRM with IBR had a significantly lower incidence of lymphedema than those in the non-reconstruction group.

Quantifying the Impact of Immediate Reconstruction in Postmastectomy Radiation: A Large, Dose-Volume Histogram-Based Analysis

To assess the impact of immediate breast reconstruction on postmastectomy radiation (PMRT) using dose-volume histogram (DVH) data. Two hundred forty-seven women underwent PMRT at our center, 196 with implant reconstruction and 51 without reconstruction. Patients with reconstruction were treated with tangential photons, and patients without reconstruction were treated with en-face electron fields and customized bolus. Twenty percent of patients received internal mammary node (IMN) treatment. The DVH data were compared between groups. Ipsilateral lung parameters included V20 (% volume receiving 20 Gy), V40 (% volume receiving 40 Gy), mean dose, and maximum dose. Heart parameters included V25 (% volume receiving 25 Gy), mean dose, and maximum dose. IMN coverage was assessed when applicable. Chest wall coverage was assessed in patients with reconstruction. Propensity-matched analysis adjusted for potential confounders of laterality and IMN treatment. Reconstruction was associated with lower lung V20, mean dose, and maximum dose compared with no reconstruction (all P<.0001). These associations persisted on propensity-matched analysis (all P<.0001). Heart doses were similar between groups (P=NS). Ninety percent of patients with reconstruction had excellent chest wall coverage (D95 >98%). IMN coverage was superior in patients with reconstruction (D95 >92.0 vs 75.7%, P<.001). IMN treatment significantly increased lung and heart parameters in patients with reconstruction (all P<.05) but minimally affected those without reconstruction (all P>.05). Among IMN-treated patients, only lower lung V20 in those without reconstruction persisted (P=.022), and mean and maximum heart doses were higher than in patients without reconstruction (P=.006, P=.015, respectively). Implant reconstruction does not compromise the technical quality of PMRT when the IMNs are untreated. Treatment technique, not reconstruction, is the primary determinant of target coverage and normal tissue doses.

Impact of immediate breast reconstruction on breast cancer recurrence and survival

The practise of Immediate Breast Reconstruction (IBR) following mastectomy for primary breast cancer is being increasingly adopted. Here the impact of IBR on disease progression and survival was assessed following treatment for invasive breast cancer. 1697 consecutive patients received surgical treatment for operable primary breast cancer between January 1996 and December 2007. Overall, 691 (41%) received mastectomy of whom 136 (20%) underwent IBR (82 Latissimus Dorsi, 54 Subpectoral). The effect of IBR on overall survival, local and distant recurrence was analysed in all patients studied and also separately within subgroups defined by Nottingham Prognostic Index (NPI) scores. The median follow up of patients studied was 55 months (range 16–148). There was no difference between IBR and mastectomy alone in survival ( p = 0.176), time to distant metastasis ( p = 0.783) or local recurrence ( p = 0.505), either overall or within Nottingham Prognostic groups.

The Impact of Immediate Breast Reconstruction On The Timing Of Mastectomy

The Impact of Immediate Breast Reconstruction On The Timing Of Mastectomy

The Impact of Immediate Breast Reconstruction on the Technical Delivery of Postmastectomy Radiotherapy

Purpose: To quantify the impact of immediate reconstruction on radiotherapy planning after modified radical mastectomy & to study radiotherapy complications. Patients and methods: After surgery, patients submitted to adjuvant radiotherapy with irradiation technique assessment using a semi-quantitative score evaluating the design of radiation fields including five objectives: breadth of chest wall coverage, homogeneity, minimization of lung irradiation, avoidance of heart and Dmax. with assessment of radiation morbidity. Results: 30 patients were enrolled at Bristol Haematology & Oncology Centre (UK) and Oncology Department, Ain Shams University hospitals (Egypt) between November 2007 and November 2009, with a mean follow up of 14.4 months. 27 patients (90%) had Latissimus Dorsi flaps & 3 (10%) had TRAM flap. The analysis revealed compromise in 24% of the plans; all are moderate compromise. Reconstruction was noticed to compromise chest wall coverage in 27%. Dose homogeneity, Dmax. and minimizing irradiated lung and heart were not affected. Compromises were more common in left side while complications were grades 1 and 2 without major morbidities. Conclusion: Immediate reconstruction may limit treatment planning of postmastectomy radiotherapy, particularly in providing adequate chest wall coverage; so candidate patients for immediate reconstruction should be aware that the presence of the reconstructed breast could cause technical difficulties.

Abstract P5-14-08: The Impact of Immediate Breast Reconstruction on Surgical Complications and the Delivery of Adjuvant Chemotherapy

Abstract Introduction: For women undergoing mastectomy immediate breast reconstruction (IBR) offers potential psychological benefits and increased quality of life. This study aimed to answer the question whether IBR might lead to higher complication rates and subsequently delay adjuvant chemotherapy (AdCT). Secondary aims included predictors for complications, and whether patients (pts) with worse tumour prognosis were less likely to undergo IBR. Materials and Methods: Retrospective analysis was performed on 220 pts who underwent mastectomy ± IBR and received AdCT. Results: Comparisons were made between the 107 pts who received IBR and 113 who had mastectomy alone (table 1). Women who were younger with less co-morbidity, lower BMI, and had better prognosis tumours were more likely to receive IBR. No statistically significant difference was found in the overall surgical wound complication rate between the groups. There was more return to surgery in the IBR group, resulting in a 9.8% (12/123) prosthesis loss rate. There was no significant difference in the average time to chemotherapy between the two groups. Conclusion: We found no evidence to suggest that IBR compromised the delivery of adjuvant chemotherapy, although there are significant risks of complications associated with reconstruction. Table 1: Comparison between women who underwent mastectomy alone (no IBR) and women who Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-08.