J Breast Cancer.  2011 Dec;14(4):322-327. 10.4048/jbc.2011.14.4.322.

Does Immediate Breast Reconstruction after Mastectomy affect the Initiation of Adjuvant Chemotherapy?

• Lee J
• Lee SK
• Kim S
• Koo MY
• Choi MY
• Bae SY
• Cho DH
• Kim J
• Jung SP
• Choe JH
• Kim JH
• Kim JS
• Lee JE
• Yang JH
• Nam SJ

• KMID: 2175730
• DOI: http://doi.org/10.4048/jbc.2011.14.4.322

Abstract

PURPOSE
The frequency of immediate breast reconstruction (IBR) is increasing, and the types of reconstruction used are diverse. Adjuvant chemotherapy is a life-saving intervention in selected high-risk breast cancer patients. The aim of our study was to determine how IBR and type of reconstruction affect the timing of the initiation of chemotherapy.
METHODS
We obtained data from female breast cancer patients treated by mastectomy with IBR (IBR group) and without IBR (mastectomy only group) who received adjuvant chemotherapy between January 1, 2008, and December 31, 2010. We retrospectively collected data including patient characteristics, disease characteristics, treatment details, and treatment outcomes from our institutional electronic patient database and medical treatment records. The reconstruction types were categorized as deep inferior epigastric perforator (DIEP) flap, latissimus dorsi (LD) flap and tissue expander/implant (TEI).
RESULTS
In total, 595 patients were included in this study. Of these patients, 43 underwent mastectomy with IBR (IBR group) and 552 patients did not undergo reconstruction (mastectomy only group). There was significant difference in the timing of the initiation of chemotherapy between the two groups (p<0.0001). There were no cases of delays of more than 12 weeks. In the IBR group, 20 patients received TEI, 9 patients were treated by the insertion DIEP flaps, and 14 patients were treated by LD flaps. There were no significant differences in the timing of chemotherapy according to the type of reconstruction (p=0.095).
CONCLUSION
IBR delays the initiation of chemotherapy, but does not lead to omission or significant clinical delay in chemotherapy. Further, the type of reconstruction does not affect the timing of chemotherapy.

Keyword

Adjuvant chemotherapy; Breast neoplasms; Breast reconstruction

MeSH Terms

Breast
Breast Neoplasms
Chemotherapy, Adjuvant
Diclofenac
Electronics
Electrons
Female
Humans
Mammaplasty
Mastectomy
Retrospective Studies
Diclofenac

Figure

• 

  Figure 1 Comparison of interval to drain removal and chemotherapy between immediate breast reconstruction (IBR) group and mastectomy only group. There were significant differences in time intervals prior to removal of surgical drains, start of chemotherapy between the two groups (p<0.0001, p<0.0001). (A) Interval to drain removal and frequency (IBR group). (B) Interval to drain removal and frequency (mastectomy only group). (C) Interval to chemotherapy and frequency (IBR group). (D) Interval to chemotherapy and frequency (mastectomy only group). SD=standard deviation.

• 

  Figure 2 Postoperative wound complication after mastectomy with immediate breast reconstruction. Wound demarcation occurred after latissimus dorsi flap reconstruction. On 42 days after operation, escharectomy and bedside debridement underwent.

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