J Breast Cancer.  2019 Mar;22(1):109-119. 10.4048/jbc.2019.22.e7.

Immediate Breast Reconstruction Does Not Have a Clinically Significant Impact on Adjuvant Treatment Delay and Subsequent Survival Outcomes

• Baek SH
• Bae SJ
• Yoon CI
• Park SE
• Cha CH
• Ahn SG
• Kim YS
• Roh TS
• Jeong J

• KMID: 2441856
• DOI: http://doi.org/10.4048/jbc.2019.22.e7

Abstract

PURPOSE
The use of immediate breast reconstruction (IBR) has been debated because it may be a causative factor in adjuvant treatment delay and may subsequently increase the probability of recurrence. We investigated whether IBR was related to adjuvant treatment delay and survival outcomes.
METHODS
We retrospectively analyzed the duration from operation to adjuvant treatment administration and survival outcomes according to IBR status among patients with breast cancer who underwent mastectomy followed by adjuvant chemotherapy from January 2005 to December 2014. Propensity score matching was performed to balance the clinicopathologic baseline characteristics between patients who did and did not undergo IBR.
RESULTS
Of 646 patients, 107 (16.6%) underwent IBR, and the median follow-up was 72 months. The median duration from surgery to adjuvant chemotherapy was significantly longer in patients who underwent IBR than in those who did not (14 vs. 12 days, respectively, p = 0.008). Based on propensity score matching, patients who underwent IBR received adjuvant therapy 3 days later than those who did not (14 vs. 11 days, respectively, p = 0.044). The duration from surgery to post-mastectomy radiation therapy (PMRT) did not significantly differ between the 2 groups. Local recurrence-free survival, regional recurrence-free survival, systemic recurrence-free survival, and overall survival were also not significantly different between the 2 groups (p = 0.427, p = 0.445, p = 0.269, and p = 0.250, respectively). In the case-matched cohort, survival outcomes did not change.
CONCLUSION
IBR was associated with a modest increase in the duration from surgery to chemotherapy that was statistically but not clinically significant. Moreover, IBR had no influence on PMRT delay or survival outcomes, suggesting that it is an acceptable option for patients with non-metastatic breast cancer undergoing mastectomy.

Keyword

Breast implants; Breast neoplasm; Chemotherapy, adjuvant; Radiotherapy, adjuvant; Recurrence

MeSH Terms

Breast Implants
Breast Neoplasms
Breast*
Chemotherapy, Adjuvant
Cohort Studies
Drug Therapy
Female
Follow-Up Studies
Humans
Mammaplasty*
Mastectomy
Propensity Score
Radiotherapy, Adjuvant
Recurrence
Retrospective Studies

Figure

• 

  Figure 1 Impact of IBR on adjuvant treatment. Duration from surgery to adjuvant chemotherapy (A) in all patients and (B) in a case-matched cohort duration. Duration from surgery to PMRT (C) in all patients and (D) in a case-matched cohort duration. IBR = immediate breast reconstruction; PMRT = post-mastectomy radiation therapy; CI = confidence interval.

• 

  Figure 2 Impact of IBR on survival outcomes. LRFS (A) in all patients and (B) in a case-matched cohort. RRFS (C) in all patients and (D) in a case-matched cohort. SRFS (E) in all patients and (F) in a case-matched cohort. OS (G) in all patients and (H) in a case-matched cohort. IBR = immediate breast reconstruction; LRFS = local recurrence-free survival; RRFS = regional recurrence-free survival; SRFS = systemic recurrence-free survival; OS = overall survival.

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