Multicentre study of patient-reported and clinical outcomes following immediate and delayed Autologous Breast Reconstruction And Radiotherapy (ABRAR study)

Background: Timing of autologous breast reconstruction in patients requiring adjuvant radiotherapy remains contentious. The primary objective of this study was to assess clinical and patient reported outcomes in immediate reconstruction with radiotherapy compared to delayed reconstruction after radiotherapy, the two relevant clinical pathways for patients who need radiotherapy.

Methods: This retrospective UK multi-centre study grouped patients into three categories: immediate reconstruction with post-operative radiotherapy (IBR); delayed reconstruction after radiotherapy (DBR); control group of immediate reconstruction without radiotherapy (noRT). Data collection utilised clinician questionnaire, patient questionnaire (BreastQ) and medical examination. Examination assessed fat necrosis, texture, symmetry and overall result.

Results: 412 patients were recruited (IBR 104; DBR 119; noRT 189) with median follow-up time of 57 months. Post-operative complications were higher in IBR & noRT (p <0.001). Total number of operations for completion of reconstruction was similar in all groups. Completion of reconstruction after mastectomy was three years longer in DBR versus IBR. BreastQ domain scores were lower in IBR versus DBR and noRT (p <0.01) but all scores were within acceptable range (satisfaction with outcome: IBR 71; DBR 85; noRT 81). Examination scores were similar for IBR and DBR but lower than noRT (p <0.01). Correlation between BreastQ and examination scores was poor.

Conclusions: Acceptable results are observed with either IBR or DBR, with high rates of patient and clinician satisfaction, low rates of complications, and a similar number of operations to complete reconstruction in all groups suggesting all options should be considered for patients.