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Comparative Study
. 2018 Feb:37:72-79.
doi: 10.1016/j.breast.2017.10.009. Epub 2017 Nov 2.

Outcomes of immediate versus delayed breast reconstruction: Results of a multicenter prospective study

Alfred P Yoon  1 , Ji Qi  1 , David L Brown  1 , Hyungjin M Kim  2 , Jennifer B Hamill  1 , Jessica Erdmann-Sager  3 , Andrea L Pusic  4 , Edwin G Wilkins  5
Affiliations
Comparative Study

Outcomes of immediate versus delayed breast reconstruction: Results of a multicenter prospective study

Alfred P Yoon et al. Breast. 2018 Feb.

Abstract

Background: Previous studies suggest that immediate reconstruction following mastectomy produces superior results over delayed procedures. However, for medical or oncological reasons, some patients may be poor candidates for immediate reconstruction. We compared complications and patient-reported outcomes between immediate and delayed breast reconstructions in a prospective, multicenter study.

Methods: 1957 patients (1806 immediate, 151 delayed) met eligibility criteria. Demographic data, major complications, infections, and reconstructive failure rates were evaluated. Patient-reported outcomes were assessed with BREAST-Q, PROMIS, and EORTC QLQ-BR23 surveys, pre- and two years post-operatively. Subscale scores were compared across cohorts using mixed-effects regression models, controlling for patient characteristics and hospitals.

Findings: Complete data were available in 1639 immediate and 147 delayed reconstruction patients. There were significant baseline differences between immediate and delayed cohorts in age, BMI, prevalence of diabetes, lymph node management, use of radiation, and chemotherapy. Controlling for clinical covariates, the delayed group had lower odds of any (OR 0.38, p < 0.001) and major (OR 0.52, p = 0.016) complications, compared with immediate patients. Furthermore, delayed reconstruction was associated with a significantly lower failure rates (6% vs. 1.3%, p = 0.032). However, multivariate analyses found no significant differences in patient satisfaction or in psychosocial, sexual, or physical well-being at two years.

Conclusions: Compared with immediate techniques, delayed reconstruction following mastectomy was associated with lower rates of overall and major complication, while providing equivalent patient satisfaction and quality of life benefits. Although immediate reconstruction is still the preferred choice of most patients and surgeons, delaying reconstruction does not appear to compromise clinical or patient-reported outcomes.

Keywords: BREAST-Q; Delayed breast reconstruction; Immediate breast reconstruction; MROC; Mastectomy; Patient reported outcomes.

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Conflict of interest statement

Conflict of interest statement

Dr. Pusic is a co-developer of the BREAST-Q which is owned by Memorial Sloan Kettering Cancer Center and she receives a portion of the licensing fees. The other authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Preoperative and Two Year Postoperative BREAST-Q Score by Reconstruction Timing. Despite statistically significant differences in patient-reported outcomes preoperatively between immediate and delayed breast reconstruction patients, both cohorts have equivalent quality of life and patient satisfaction at two years postoperatively.
Fig. 2
Fig. 2
Preoperative and Two Year Postoperative EORTC Body Image Score by Reconstruction Timing. The substantially negative body image perception of the delayed reconstruction patients become equivalent with the immediate breast reconstruction patients at two years postoperatively.
See this image and copyright information in PMC

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