Immediate Breast Reconstruction Risks
Posted 10/21/2010
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There has been a growing trend to offer women, who need mastectomies, immediate breast reconstruction. This has the obvious advantage of a single major surgery (there are always small ones to "tweak" the reconstructed breast and immediate area) and not have to contend with a flat chest. As this surgery has become more common, there have been studies to examine the possible risks. Specifically, the concerns focus on possible damage to the new breast from post-op radiation therapy and whether chemotherapy might delay good healing. As always, the advice is to speak with your doctors about your particular situation. It is never "one size fits all." I wrote about this several days ago, and here is a quote from Journal Watch about another study and then a link to read more:
The Multidisciplinary Spectrum of Cancer Therapy: Effects on Immediate Breast Reconstruction
More-selective use of postmastectomy radiotherapy is appropriate; use and timing of chemotherapy might not affect surgical outcomes.
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Mounting evidence shows that PMRT after IBR leads to unacceptably high complication rates. During the last decade, use of PMRT for patients with early-stage breast cancer has increased, based mostly on data from trials conducted 25 to 50 years ago. Unquestionably, radiotherapy after mastectomy is effective at lowering risk for locoregional recurrence (LRR) and is indicated in breast cancer patients with >4 positive nodes and LRR risk >15%.
However, the need for PMRT in early-stage breast cancer patients has been debated for decades, particularly because advances in all treatment modalities have been substantial (JW Oncol Hematol Jun 22 2010 (Link to: http://oncologyhematology.jwatch.org/cgi/content/full/2010/622/1) ).
For most women with early-stage breast cancer, PMRT provides little benefit; in the first study, the number of patients who received PMRT seems higher than would be expected for U.S. practice. As an editorialist suggests, more-selective use of PMRT is preferable to delaying or withholding the well-known psychological benefits of IBR.
Chemotherapy will be recommended for most women with primary tumors >1 cm; therefore, the potential negative effects of chemotherapy on IBR outcomes must be recognized. Of note, the second study shows that rates of these untoward consequences are not related to the timing of chemotherapy (i.e., neoadjuvant or adjuvant), nor, indeed, to whether the patient receives chemotherapy at all. Both studies are timely and essential because they emphasize the complexities faced by both patients and their caregivers regarding multidisciplinary cancer care and the potential complications associated with breast reconstruction.
http://oncology-hematology.jwatch.org/cgi/content/full/2010/1019/1
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