A systematic review on the effect of immediate autologous microsurgical breast reconstruction on the timely initiation of adjuvant therapy

Aim: Postoperative administration of adjuvant therapy is associated with reduced breast cancer recurrence and mortality. Concerns have been raised that immediate reconstruction may lead to a delay in the administration of adjuvant therapy with the risk of compromising survival. This systematic review seeks to evaluate and discuss whether post-mastectomy immediate autologous microsurgical breast reconstruction affects the timely initiation of adjuvant chemotherapy and radiotherapy. Methods: PubMed and EMBASE were searched to identify studies assessing the impact of immediate autologous microsurgical breast reconstruction on the timely initiation of adjuvant therapy. Results: Seven studies comprising 267 patients treated with immediate autologous microsurgical reconstruction followed by adjuvant therapy and 2,622 patients treated with mastectomy-only followed by adjuvant therapy were included in this study. Reconstructed patients started adjuvant therapy later, with a mean difference ranging from 2 to 14 days. Adjuvant therapy was initiated after 4-10 weeks in most cases- regardless of reconstruction or not- and only few examples of delays of more than 12 weeks were recorded. Major postoperative complications were found to be associated with delay in the initiation of adjuvant therapy. Conclusion: The literature generally agrees that delays in adjuvant therapy beyond 12 weeks after surgery are associated with increased breast cancer recurrence and mortality, but uniform data on the clinical effects of delays within this interval are lacking. The association between postoperative complications and delays in adjuvant therapy underlines the importance of careful patient selection, a multidisciplinary treatment approach, and other measures known to reduce the risk of complications.