Surgical complications after immediate breast reconstruction vs. mastectomy alone: impact on the time to delivery of adjuvant therapy

Background: When mastectomy is planned in women with breast cancer who wish to have a breast reconstruction, there is a choice between immediate and delayed breast reconstruction. Mastectomy combined with immediate breast reconstruction (IBR) is, however, a more complex procedure than mastectomy alone. It is therefore of concern if adding IBR may result in a higher complication rate and thus a risk of delaying adjuvant therapy. The aim of this study was to compare the time from surgery to initiation of adjuvant therapy between women having a mastectomy and IBR with women having a simple mastectomy, and to evaluate if the postoperative complications may postpone the adjuvant therapy for women diagnosed with stage I-III breast cancer. Methods: This retrospective cohort study included all women who underwent a mastectomy from November 2015 to March 2017 at Odense University Hospital (n=314 mastectomies). The medical records were reviewed regarding patient demographics, health characteristics, post -operative complications and time from surgery to initiation of adjuvant therapy. Women were stratified according to surgery, simple mastectomy or mastectomy with IBR. Results: The group of women receiving IBR were younger (age 46 vs. 59 years, P<0.001). Adjuvant chemotherapy (ACT) was administered to 20 women in the IBR group and 59 women in the simple mastectomy group. The mean time from surgery to adjuvant therapy was 33 days for the IBR group and 32 days for the simple mastectomy group (P=0.864). The number of post -operative major complications were significantly higher among women having IBR compared to simple mastectomy (15% vs. 0%, P=0.014). Conclusions: IBR can safely be offered to selected women with stage I-III breast cancer. There was no difference between the time from surgery to adjuvant therapy, when comparing mastectomy with IBR to simple mastectomy in this study.