Does immediate breast reconstruction delay delivery of adjuvant treatment? First results of the iBRA-2 prospective multicentre cohort study


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Shelley Potter1
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Abstract

Background

Immediate 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 the delivery of adjuvant oncological treatments and compromise long-term oncological outcomes.  High-quality evidence, however, is lacking.  iBRA-2 is a national prospective multicentre cohort study that aimed to investigate the effect of IBR on the delivery of adjuvant therapy.    

Method

Breast and plastic surgery centres performing mastectomy with or without (+/-) IBR were invited to participate in the study through the trainee research collaborative network.  All women undergoing mastectomy+/-IBR for breast cancer between 1st July and 31st December 2016 were eligible for inclusion.  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 to determine the impact that IBR has on the time of delivery of adjuvant therapy. 

Results

2631 patients were recruited from 76 centres of whom, 1065 (40.5%) underwent IBR.  708 (26.9%) patients received implant-based reconstruction; 105 (4.0%) pedicled-flaps and 244 (9.3%) free-flap reconstructions.  Complications were experienced by 37.1% (n=958) patients.  There were no significant differences in complication rates between procedure types (p=0.16), but patients undergoing IBR were significantly more likely to require readmission (p<0.00) or reoperation (p<0.00) for complications than undergoing mastectomy only.  Adjuvant chemotherapy or radiotherapy was required by 1241 (47.2%) patients and no differences were seen in time to delivery of adjuvant therapy between patient groups.

Conclusion

IBR is associated with a higher rate of complications requiring readmission to hospital or re-operation compared to mastectomy alone but does not appear to significantly impact the time to delivery of adjuvant therapy.  This study provides important information to guide patients and professionals making decisions regarding reconstructive surgery in the future.