Timing of Post-Mastectomy Reconstruction Unlikely to Influence Breast Cancer Recurrence Rates, Study Results Show

Patients with breast cancer who underwent breast reconstruction immediately after their mastectomy were at a similar risk for disease recurrence as those who waited to receive reconstructive surgery, according to findings from a recent study.

“Because of logistical challenges, concerns about delays in adjuvant treatment (therapy given after surgery to reduce the risk for disease recurrence), and concerns of impaired outcomes of post-mastectomy breast reconstruction in combination with adjuvant radiotherapy, breast reconstruction is often performed in a delayed fashion,” the authors wrote in a study published in Cancer.

However, the investigators explained, there has recently been more of an emphasis on performing immediate post-mastectomy reconstructions as some studies found them superior in terms of several aspects including patient satisfaction. But there are growing concerns that this strategy is unsafe.

“According to the concept of tumor dormancy, (patients with) breast cancer might harbor dormantmicrometastases that can be activated by stressors, such as extensive surgery, thereby inducing recurrence and metastasis,” they wrote.

There has been limited evidence to support which approach is best in terms of recurrence rates, according to the investigators. As a result, decisions to perform immediate or delayed post-mastectomy reconstruction are based on expert opinion.

Here, the authors assessed scientific evidence to determine if delaying post-mastectomy breast reconstruction leads to different recurrence and metastases rates than immediate reconstructive surgery among patients with primary breast cancer. The purpose of the review was to provide more insight into shared decision-making between patient and provider.

The investigators reviewed the results of 55 studies that evaluated the timing of post-mastectomy reconstructive surgery in 14,452 patients with breast cancer. Most of the procedures occurred immediately after mastectomy (12,480 patients) while the rest were either delayed (1,852 patients) or it was unclear when the post-mastectomy reconstruction occurred (337 patients).

After an analysis of several studies, the authors concluded that there were similar recurrence rates between patients with breast cancer who underwent immediate and delayed post-mastectomy breast reconstruction.

“Personalized health care is increasingly becoming standard of care for patients with breast cancer,” they wrote. “Ideally, each patients’ treatment strategy is aligned with patients’ genotypic, phenotypicand clinical characteristics, as well as patients’ personal preferences.”

With this in mind, decision aids have become popular in supporting shared decision-making. A decision aid is a tool that helps patients and providers talk with each other about treatment and care options. This tool helps patients understand what choices they have and the pros and cons of each option.

The problem with decision aids with breast reconstruction, according to the study authors, is that they are mostly designed to educate the general population about their reconstructive options.

“Because of lack of detailed data on oncological outcomes after different methods and timings, it is not surprising that information on oncological outcomes is not included in current (decision aids),” they wrote. “Moreover, due to various reasons (e.g., previous surgery or radiotherapy, body type), not all patients are eligible for al reconstructive options. To support (shared decision-making) and improve personalized patient information, patient education should be adjusted to the specific characteristics of the individual.

“This tailored information can only be achieved through better understanding of differences in oncological outcomes after (post-mastectomy breast reconstruction),” the authors concluded. “Based on current evidence, oncological concerns do not seem a valid reason to withhold patients from certain reconstructive timings or techniques, and patients should equally be offered all reconstructive options they technically qualify for.”

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