Immediate Breast Reconstruction Allows for the Timely Initiation of Post-Mastectomy Radiation Therapy

Ronnie L Shammas, Yi Ren, Samantha M Thomas, Scott T Hollenbeck, Rachel A Greenup, Rachel C Blitzblau
Plastic and Reconstructive Surgery 2019 June 7

INTRODUCTION: Surgical complications resulting from breast reconstruction may delay the initiation of PMRT, which can impact breast cancer outcomes. We hypothesized that immediate breast reconstruction may be associated with delays in the initiation of PMRT, but that this delay would not significantly impact overall patient survival.

METHODS: Using the National Cancer Database, we identified women with breast cancer who underwent mastectomy and received PMRT within 1 year of surgery. Delayed PMRT was defined as treatment initiated ≥6 months after surgery in patients who received adjuvant chemotherapy, or as ≥12 weeks after surgery in patients who received neoadjuvant or no chemotherapy.

RESULTS: Overall, 171,136 patients were identified. Women undergoing breast reconstruction had an increased median time to PMRT, 154 (IQR, 64-196) vs. 132 days (IQR, 52-188.5) (p<0.001), and on logistic regression were more likely to experience a delay in initiating PMRT (OR, 1.25; 95% CI, 1.188-1.314). Other factors associated with delayed PMRT included: increased Charlson-Deyo scores, neoadjuvant chemotherapy, non-private insurance, and black race. Cox Proportional Hazards models revealed no evidence of a reduced adjusted overall survival in the immediate breast reconstruction group (HR, 0.836; 95% CI 0.802-0.871, p<0.001). Restricted cubic spline analysis identified the threshold number of days at which the start of PMRT began to impact survival at 169 (95% CI, 160-190), 75 (95% CI, 42-90), and 71 (95% CI, 41-90) days in patients undergoing adjuvant, neoadjuvant, and no chemotherapy, respectively.

CONCLUSION: Immediate breast reconstruction is associated with a modest delay in initiating PMRT but does not impact overall survival.


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