by Cohen, Oriana; Lam, Gretl; Choi,
Mihye; Ceradini, Daniel; Karp, Nolan
Background: Concerns
exist that immediate breast reconstruction may delay adjuvant chemotherapy
initiation, impacting oncologic outcomes. Here, the authors determine how
postoperative complications impact chemotherapy timing, and identify factors
associated with greater risk for delays. Methods: Retrospective chart review
identified patients undergoing immediate breast reconstruction and adjuvant
chemotherapy at a single institution from 2010 to 2015. Patients were analyzed
based on occurrence of postoperative complications and time to chemotherapy.
Results: A total of 182 patients (244 breast reconstructions) were included in
the study; 210 (86 percent) reconstructions did not experience postoperative
complications, and 34 (13.9 percent) did. Patients who experienced
postoperative complications had an older mean age (53.6 years versus 48.1
years; p = 0.002) and higher rates of diabetes (23.5 percent versus 3.8
percent; p < 0.001). The complication group had delays in initiation of
chemotherapy (56 versus 45 days; p = 0.017). Patients who initiated
chemotherapy more than 48.5 days after reconstruction were of older mean age
(55.9 years versus 50.7 years; p = 0.074) and had increased rates of diabetes
(36.8 percent versus 6.7 percent; p = 0.053) and immediate autologous
reconstruction (31.6 percent versus 0 percent; p = 0.027). A predictive model
determined that patients with at least one of these three risk factors have a
74 percent chance of experiencing prolonged times to chemotherapy initiation.
Conclusions: Risk factors for delayed chemotherapy in the context of
postoperative complications are age older than 51.7 years, diabetes, and
autologous reconstruction. Reconstructive candidates who fit this profile are
at highest risk and merit extra consideration. CLINICAL QUESTION/LEVEL OF
EVIDENCE: Risk, III.
