For women undergoing mastectomy for breast cancer, immediate breast reconstruction has a low risk of complications - including serious complications related to radiation therapy - and does not cause undue delays in cancer treatment, reports a study in the July issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
The results alleviate concerns that immediate reconstruction leads to increased complications and other problems after mastectomy. "These findings make a strong argument for immediate reconstruction regardless of cancer stage," according to the study by ASPS Member Christopher A. Crisera, MD of UCLA Medical Center and colleagues.
The researchers evaluated a significant number of women with advanced breast cancer who underwent breast reconstruction immediately after mastectomy. Over a ten-year period, immediate reconstruction was performed on 170 women, including reconstruction of both breasts in 13 patients. The reconstructions were mainly done using tissues from the abdominal area (TRAM flaps).
The outcomes of immediate breast reconstruction were analyzed, focusing on complication rates, timing of other cancer treatments and cosmetic results. The goal was to determine whether the proven benefits of immediate reconstruction were justified in terms of the risks and possible adverse effects.
There were 15 major complications: a rate of 8.8 percent. The complications led to delays in further cancer treatments (chemotherapy and/or radiation) in only eight patients, with a maximum delay of three weeks. Fifteen women had recurrent breast cancer during follow-up; immediate reconstruction did not cause any delays in recognizing these recurrences.
An important goal of the study was to determine whether immediate reconstruction contributed to any complications of radiation therapy for breast cancer. Long-term follow-up of 69 women undergoing radiation therapy found a 30 percent rate of relatively minor flap shrinkage. However, only about 10 percent of women had severe breast distortion. "Importantly, the overall cosmetic outcome in patients who received postoperative radiation was comparable to those who did not," Dr. Crisera and colleagues write.
For women undergoing mastectomy for breast cancer, immediate breast reconstruction offers several advantages over delayed reconstruction, including improved cosmetic outcomes, shorter recovery time, and decreased costs. Immediate reconstruction is also an important coping mechanism associated with improved quality of life and a reduced risk of depression. Yet there's continued debate over its use, with some surgeons fearing immediate reconstruction will increase the risk of complications or delay further cancer treatments.
The new study of immediate breast reconstruction is one of the largest to date. The results suggest that immediate reconstruction is safe and well tolerated by patients, and does not lead to an increased risk of complications. Delays in further treatment appear comparable to those of women undergoing mastectomy alone. The study also suggests that a "vast majority" of women experience no or only minor complications related to radiation therapy.
The authors hope their results will reassure women with breast cancer - and their surgeons - that immediate breast reconstruction is a safe and beneficial alternative to waiting weeks or even months for reconstruction. Dr. Crisera and c-oauthors believe that the proven benefits of immediate breast reconstruction should not be denied for fear of complications or other safety problems.
Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.