A comparison of surgical complications between immediate breast reconstruction and mastectomy: the impact on delivery of chemotherapy--an analysis of 391 procedures

Ann Surg Oncol. 2012 Feb;19(2):560-6. doi: 10.1245/s10434-011-1950-6. Epub 2011 Jul 27.

Abstract

Purpose: To compare the postoperative complications after immediate breast reconstruction (IBR) versus mastectomy alone and to examine the impact on the delivery of chemotherapy.

Methods: In this prospective series, there were 391 consecutive women who underwent mastectomy (243 mastectomy alone and 148 mastectomy and IBR). The outcome measures were complications (within 3 months after surgery) and time to adjuvant chemotherapy.

Results: Compared to the IBR group, patients in the mastectomy alone group were significantly older (P < 0.0001), smokers (P = 0.007) and less likely to have had previous radiation or lumpectomy (P < 0.0001). Overall, the complication rate was significantly greater in the IBR group than mastectomy alone (27.0% vs. 15.6%, P = 0.009). Univariate analyses revealed that mastectomy with IBR [odds ratio (OR) = 2, 95% confidence interval (CI) 1.21-2.30]; bilateral procedure (OR = 1.84, 95% CI 1.07-3.16); previous radiotherapy (OR = 2.4, 95% CI 1.29-4.47); and previous lumpectomy (OR = 1.84, 95% CI 1.11-3.03) were significant predictors of increased complications. With multivariable analysis, none of these variables were significantly associated with increased complications. 106 patients received adjuvant chemotherapy; median time from mastectomy to chemotherapy was 6.8 (0.71-15) weeks in the mastectomy alone group (n = 96) compared to 8.5 (6.3-11) weeks in the IBR group (n = 10) (P = 0.01).

Conclusions: Although the incidence of overall and major postoperative complications was higher after IBR than mastectomy alone, there were no significant relationships in the multivariable analysis. IBR was associated with a modest increase in time to chemotherapy that was statistically but not clinically significant.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Breast Neoplasms / drug therapy
  • Breast Neoplasms / surgery*
  • Carcinoma, Ductal, Breast / drug therapy
  • Carcinoma, Ductal, Breast / surgery*
  • Carcinoma, Lobular / drug therapy
  • Carcinoma, Lobular / surgery*
  • Chemotherapy, Adjuvant
  • Female
  • Follow-Up Studies
  • Humans
  • Lymphatic Metastasis
  • Mammaplasty*
  • Mastectomy*
  • Mastectomy, Segmental
  • Middle Aged
  • Models, Statistical
  • Neoplasm Staging
  • Postoperative Complications*
  • Prognosis
  • Prospective Studies

Substances

  • Antineoplastic Agents