Does the Timing of Chemotherapy Affect Post-Mastectomy Breast Reconstruction Complications?

Introduction: In this study we evaluated how the timing of chemotherapy for breast cancer affects post-reconstruction complications to determine whether there is an optimal time for breast reconstruction after chemotherapy.

Patients and methods: A retrospective review identified 344 breast cancer patients who underwent chemotherapy with mastectomy and autologous/prosthetic reconstruction from 2011 to 2014. A control group of 127 breast cancer patients who underwent mastectomy and autologous/prosthetic reconstruction without chemotherapy was also identified from the same period. The 2 groups were compared and analyzed for differences in demographic characteristics, treatment, and postoperative complication rates. The chemotherapy group was subsequently stratified into 3 subgroups on the basis of the number of days between chemotherapy treatment and reconstructive surgery (≤ 30 days, 30-60 days, > 60 days) for further analysis.

Results: Patients who received chemotherapy were followed for an average of 803.4 days (26.4 months) from the time of initial reconstruction (mean time to complication, 43.3 ± 82.7 days), and experienced an overall greater complication rate compared with control subjects (32.8% vs. 24.4%; P = .078). When complications were divided into minor, major, and reconstructive failure categories, analysis revealed that the chemotherapy group experienced more minor complications than the control group (18% vs. 11%; P = .067). However, there were no statistically significant differences in major complication rates (10.5% vs. 9.4%) and reconstructive failure complication rates (3.8% vs. 2.4%) between the chemotherapy group and control group. Sixty-eight patients (19.8%) underwent surgery within 30 days of chemotherapy, 210 patients (61%) within 30 to 60 days, and 66 patients (19.2%) after 60 days. Of note, patients in the ≤ 30 days group underwent surgery at a mean time of 24.8 days with 2 patients who underwent surgery in < 15 days. The 3 groups did not differ with respect to demographic factors or breast reconstructive modality, and there were no significant differences in overall complication rates (33.8% for ≤ 30 days, 31.4% for 30-60 days, and 36.4% for > 60 days), time to complication, complication severity, or complication type. Whereas patients who underwent surgery 30 to 60 days from the time of chemotherapy had lower rates of skin necrosis (3.8%) and infection (15.7%) compared with the ≤ 30 days and 60 to 90 days groups, this finding was not statistically significant.

Conclusion: Results of this study suggest that chemotherapy does increase overall breast reconstruction complications, however, a decreased time between chemotherapy and surgical reconstruction does not predispose patients to postoperative complications. Consequently, surgery might be feasible in close temporal proximity to chemotherapy administration.