Author Dr. Minas Chrysopoulo 

Is immediate breast reconstruction safe?

Breast Reconstruction Does Not Impede Chemotherapy, Recovery or Diagnosis of Breast Cancer Recurrence.

Debunking the myth that women with locally advanced breast cancer must wait until after chemotherapy to have their breast reconstructed, a study presented at the Annual ASPS/PSEF/ASMS Meeting found that immediate free flap reconstruction for women with breast cancer is safe and psychologically beneficial.

The study, which followed 170 patients with locally advanced breast cancer, found that immediate reconstruction did not delay post-operative chemotherapy, prolong recovery or hinder the diagnosis of local cancer recurrence.

“Losing a breast is traumatic,” said ASPS Member James Watson, MD, and participating surgeon in the study. “As a board-certified plastic surgeon, I wanted to ensure that immediate breast reconstruction was safe for my patients and would make the healing process easier. The findings in this study will allow women to start healing sooner psychologically, knowing that their decision will not impede their physical progress against breast cancer.”

The paper states that women participating in the study were pleased with their immediate reconstruction experience, indicating an immeasurable emotional benefit patients gain by having the reconstruction right away.

According to the findings, the majority of patients were either satisfied or very satisfied with their reconstruction and, if they had to, would have it done immediately after their mastectomy again. Also, the majority of women agreed they would recommend immediate reconstruction to a friend or colleague.

Through the study, Dr. Watson found that immediate free flap reconstruction – where the patient’s own tissue is removed from the abdomen, buttocks or thigh regions and reattached in the breast using microsurgical techniques – resulted in similar complications and delays of post-operative chemotherapy to patients who delayed reconstruction. The most common postponement for patients was waiting for the wound to heal. However, the maximum delay was only three weeks, which did not have significant oncological impact on their post-operative therapy.

Also, while there were local recurrences of the cancer, physicians were able to diagnose the cancer’s return quickly, resulting in no delay for additional treatment. Most local recurrences were located at the mastectomy scar or in the mastectomy flaps, which could be diagnosed by a physical exam and biopsy.

“An added benefit to reconstructing the breast immediately is that it’s easier for the oncology surgeon to complete the mastectomy. Often, the breast cancer is so large or involves so much skin that the surgeon has to remove additional skin in the region, making it difficult to reserve enough tissue to close the wound,” stated Dr. Watson. “With immediate reconstruction, the oncologic surgeon can eliminate more breast skin to ensure the cancer is removed and use the skin from the free flap procedure to close the wound.”

According to ASPS 2001 statistics, more than 190,000 women were diagnosed with breast cancer and more than 80,000 women opted for breast reconstruction following a mastectomy. Access to breast reconstruction following a mastectomy has increased due to the passage of the Women’s Health and Cancer Rights Act 1998, proudly supported by ASPS, which mandated insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone a mastectomy.

“With the finding that reconstruction right after mastectomy is safe, women can maximize their opportunity to not only heal physically but also psychologically right away,” said Dr. Watson. “Before, women had to wrestle with their changed body image after losing a breast while physically recovering from their battle with cancer. Now, they don’t have to delay the psychological healing process of beating breast cancer and celebrating that victory.”