The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: The iBRA-2 Study

Background
Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy.

Methods
Consecutive women undergoing mastectomy+/-IBR for breast cancer July-December,2016 were included. Patient demographics, operative, oncological, and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy+/-IBR were compared and risk-factors associated with delays explored.

Results
2,540 patients were recruited from 76 centres; 1,008 (39.7%) underwent IBR (implant-only [n=675,26.6%]; pedicled-flaps [n=105,4.1%] and free-flaps [n=228,8.9%]). Complications requiring readmission or reoperation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1,235(48.6%) patients. No clinically-significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays.

Conclusion
IBR does not result in clinically-significant delays to adjuvant therapy but post-operative complications are associated with treatment delays. Strategies to minimize complications including careful patient selection are required to improve outcomes for patients.