Breast reconstruction at the time of mastectomy does not delay post-operative chemotherapy for women with breast cancer

Performing breast reconstruction surgery at the time of mastectomy does not delay post-operative chemotherapy for women with breast cancer, according to the first study designed to answer the question. The study appears in the September issue of Archives of Surgery.

“At most academic centers that routinely care for women with breast cancer, immediate breast reconstruction is the norm for women who opt for mastectomy,” said Richard Bold, associate professor of surgical oncology at UC Davis Cancer Center and senior author of the study. “However, a number of our patients come to us after having been told elsewhere that they should not have immediate reconstruction because it delays chemotherapy. We felt it was an important question to settle.”

Breast reconstruction has been shown to lessen the impact of mastectomy on a woman’s self-image and psychosocial well-being; these benefits are more pronounced when reconstruction is performed at the time of mastectomy rather than in a later surgery. However, some surgeons — concerned about skin infections and other wound complications that might delay chemotherapy — advise women to postpone reconstruction.

Chemotherapy is typically initiated four to six weeks after mastectomy. Longer delays may increase the risk of cancer recurrence or jeopardize survival. Because chemotherapy drugs can slow wound healing, patients with severe wound complications may have to postpone the therapy until the wound improves.

Bold and his colleagues reviewed the charts of 128 women who underwent mastectomy at UC Davis Cancer Center between 1995 and 2002. They found that while wound complications were more common with immediate reconstruction, the complications were too mild — minor skin infections and small scabs, primarily — to warrant any delay in starting chemotherapy.

Of the 128 women, Bold and his colleagues identified four whose chemotherapy was delayed beyond six weeks because of wound complications. Two of the four women had undergone immediate breast reconstruction. Two had mastectomy alone without reconstruction.

“The findings weren’t a surprise to us, but we wanted to document the safety of immediate breast reconstruction so that surgeons in other settings can have the same confidence in the approach,” Bold said.

In addition to the potential psychological benefits of immediate breast reconstruction, Bold said cosmetic outcomes also tend to be better with immediate surgery.

“When we begin the reconstruction process at the time of mastectomy, we do a skin-sparing mastectomy that preserves more skin,” he said. “Reconstruction tends to look better when native skin can be used rather than stretched or transplanted skin.”

Of the approximately 200,000 women diagnosed with breast cancer in the United States each year, more than half will undergo mastectomy. The recommendations for the use of chemotherapy have expanded so that most women, even those with early breast cancer, receive post-operative chemotherapy.

UC Davis Cancer Center is the only National Cancer Institute-designated cancer center between San Francisco and Portland, Ore., and is ranked by U.S. News & World Report as one of the nation’s top 50 cancer treatment centers.