Cancer du sein : recherche actuelle

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Immediate Breast Reconstruction does not Delay Adjuvant Chemotherapy nor affect Clinical Outcome

Chan MYP, Ho SYM, Thambiah M, Seah DW, Chen JC, Lu QS, Cheong EC and Tan EY*

Background: Post-operative complications are more frequent after immediate breast reconstruction and there are concerns that it adversely affects clinical outcome.

Objectives: We reviewed the rate of early and late complications after immediate breast reconstruction and evaluated their impact on adjuvant treatments and outcome.

Methods: Retrospective review was performed of 146 women who underwent immediate breast reconstruction after mastectomy for breast cancer from 1st January 2001 to 31^st December 2010.

Results: Median patient age was 46 years and all women had no major co-morbidities. More than half the women had early-stage cancers. Reconstruction was performed with a pedicled transrectus abdominis myocutaneous flap in 109 patients, a latissimus dorsi flap in 29, a free deep inferior epigastric perforator flap in 4 and implants were inserted in 4 patients. Two patients suffered a cerebrovascular accident and one a cardiac event but all recovered fully. Early post-operative wound complications within 30 days of surgery occurred in 25 patients (17%). All, except one, were managed conservatively. Late complications occurred in 18 patients and 7 patients underwent further surgery, which most often involved abdominal hernia repair. Complications were more frequent in older patients, diabetics and those with implants inserted (P<0.01, P=0.05, P=0.01 respectively). Adjuvant treatments proceeded as planned in most cases, with wound complications delaying initiation of chemotherapy for longer than 3 months in only 3 patients. We observed no correlation between post-operative complications and disease recurrence, whether local or distant (P=0.39, P=1.00 respectively) and reconstruction together with cancer surgery did not increase the likelihood of disease recurrence (P=0.08).

Conclusions: Post-operative complications after immediate breast reconstruction did not delay planned adjuvant treatments nor did it increase the risk of disease recurrence. This study affirms the oncological safety of immediate reconstruction following mastectomy for breast cancer.