Investigating the time to adjuvant treatment following immediate breast reconstruction in breast cancer patients

Background: Mastectomy is still recommended in up to 40% of patients with breast cancer. National Institute of Clinical Excellence (NICE) guidelines mandate that post -mastectomy immediate breast reconstruction (PMIBR) should be offered to all suitable patients. However, it is still a matter of debate if immediate breast reconstruction causes a delay in administering adjuvant therapies to patients with breast cancer. The primary aim of this study is therefore to explore any associations between immediate breast reconstruction and unacceptable delay to delivering first adjuvant treatment. Methods: A retrospective study was undertaken during a 4 -year period [2015-2018] in the Breast Surgery unit at Guy's and St Thomas' NHS Foundation Trust (GSTT). Statistical analysis, comparing time to adjuvant treatment in the immediate reconstruction and control groups, was performed. A total of 168 patients undergoing immediate reconstruction and receiving adjuvant treatment were identified through an electronic database. This group was compared with a control group of 85 age -matched patients that underwent standard breast conserving surgery or mastectomy with no reconstruction who also received adjuvant treatment, during the same time period. Regression analysis was undertaken to adjust for confounding effects. Results: The mean time to adjuvant treatment in the immediate reconstruction group and the control group was 65.4 and 65.3 days respectively. Out of the 168 patients who underwent mastectomy with immediate reconstruction, 20 (11.9%) had a delay to their adjuvant treatment and of these in 11 (6.5%) the delay was directly related to their PMIBR surgery. Multiple regression analysis showed no significant difference. Conclusions: There was no significant statistical difference with regards to timing to first adjuvant treatment following immediate breast reconstruction in the study group and the control group. These results support the current practice on our unit, as well as national guidelines for PMIBR. Further studies however are warranted to define what is considered as acceptable 'delay' to delivering adjuvant therapy and the adverse impact on outcome.