Immediate breast reconstruction and time to adjuvant therapy - Results from the iBRA-2 (immediate Breast Reconstruction and Adjuvant therapy) multi-centre prospective cohort study

Introduction

Immediate breast reconstruction (IBR) is routinely offered to improve quality of life for women with breast cancer requiring a mastectomy. There are concerns that more complex reconstructive surgery may delay the delivery of adjuvant treatments and compromise long-term oncological outcomes. Previous studies addressing this research question have yielded conflicting results. iBRA-2 is a national prospective multicentre cohort study with the aim of investigating the effect of IBR on the delivery of adjuvant therapy and long-term oncological outcomes.

Methods

Breast and plastic surgery centres performing mastectomy with or without (+/−) IBR using any technique were invited to participate in the study through the UK trainee research collaborative network. Consecutive women undergoing mastectomy +/− IBR for breast cancer between 1st July 2016 and 31st December 2016 were recruited into the study. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy +/− IBR were compared to determine if IBR impacted on the time of delivery of adjuvant therapy.

Results

2,548 patients were recruited from 76 centres, of whom 1,016 (39.9%) underwent IBR. 675 (26.5%) patients received implant-based reconstruction; 105 (4.1%) pedicled-flaps, and 228 (8.9%) free-flap reconstructions. 932 patients (36.6%) experienced at least one complication. There were no significant differences in complication rates between procedure types (p = 0.12), but patients undergoing implant-based or free-flap reconstruction were significantly more likely to require re-admission (p < 0.001) or re-operation (p < 0.0001) for complications. 1,241 patients accepted adjuvant treatment, of whom 431 (34.7%) had undergone IBR. Patients undergoing IBR were less likely to be recommended for either adjuvant chemotherapy (22.4% vs 27.5%, p < 0.001) or radiotherapy (29.0% vs 40.1%, p < 0.001). The median time to adjuvant therapy (53 days, IQR 41–65 days) was not influenced by IBR (p = 0.22). On multivariable analysis, breast/donor site complications (Odds Ratio = 5.64, Confidence Interval 3.56–8.94), obesity (OR = 2.65, 1.34–5.18), and readmission to hospital (OR = 5.79, 3.08–10.90) were significantly associated with delay to adjuvant treatment.

Conclusions

IBR does not lead to clinically significant delays to delivery of adjuvant therapy. This study provides important information to guide patients and professionals making decisions regarding reconstructive surgery in the future.