Some Women May Benefit from Delaying Breast Reconstruction After Mastectomy, New Research Suggests
Mastectomy can be a daunting, but incredibly effective treatment for women who are diagnosed with breast cancer. In the surgery, all breast tissue is removed from the infected breast in an effort to treat or remove cancerous cells, but for women who undergo this surgery, the end result leaves much more missing than just the cancer. While there are alternative surgical options available for breast-cancer treatment, they tend to be more expensive, and can lead to varying levels of success.
Breast cancer patients are typically recommended immediate breast reconstruction by their surgeons following a mastectomy. The decision to receive immediate breast reconstruction is often discussed before the mastectomy takes place. Immediate breast reconstruction is usually a preventative recommendation in anticipation of psychosocial problems that arise in patients who receive a mastectomy. Immediate reconstruction will also often lead to better cosmetic outcomes than if the woman waits for a period of time after the surgery.
In many cases, however, the recommendation for immediate breast reconstruction does not take into account various risk factors that could lead to complications. It is possible during breast reconstruction for previous conditions or underlying risk factors to lead to infection, noninfectious wounds, and other serious complications. In the worst possible cases, these complications can lead to permanent damage and a severely decreased quality of life.
This does not mean that breast reconstruction surgery is dangerous, or that the only options are immediate surgery or none at all. A study conducted by Margaret A. Olsen, Phd, MPH, and her colleagues at the Washington University School of Medicine, St. Louis, suggests that simply delaying breast reconstruction and giving the body a chance to heal from mastectomy could be beneficial for women with applicable risk factors.
The Process of Breast Reconstruction
Not all women will choose breast reconstruction, and the process begins with a conversation between the patient and doctor to determine what type of breast reconstruction will be the most beneficial. There are many factors to take into account in even a low-risk situation, which involve careful consideration of the size and area of the cancer, how many surgeries might be required, and what the final outcome of the surgery might be.
Oftentimes, breast cancer treatment requires operation on only one breast. Matching the healthy breast is often the key concern in these cases. The reconstruction options available will be determined by the surgeon according to a woman’s age, body-type, breast size, lifestyle, goals, and overall health. Possible consequences and the effects that reconstruction surgery might have on the rest of the body vary from person to person, so it is important that individuals establish a trust relationship with their doctors and a surgeon before settling on anything.
Reconstructive surgery often requires more than one procedure, and there are two primary methods of reconstructing the breast. The first option is to use implants, either silicone or saline inserts, to shape the breast artificially. The second method is called a tissue flap procedure, in which tissue from other parts of the body, usually the stomach, is used to reconstruct the breast. Sometimes both implant and tissue flap procedures are necessary for the best results.
At this point, the patient will choose between immediate breast reconstruction, or delayed breast reconstruction. The study conducted by Olsen and her colleagues defines immediate breast reconstruction as any procedures that begin within seven days of receiving a mastectomy. Delayed reconstruction could come at any point after the initial seven-day period, and there are several reasons aside from health complications that delayed reconstruction would be desirable.
Some women have a hard time coping with the idea of reconstruction and loss of breast shape due to the cancer treatment. In this case, it is okay to opt out of immediate treatment in order to make a decision after the mastectomy has occurred. Doctors will also recommend against immediate reconstruction if a woman needs radiation therapy, as radiation can cause delayed healing and scarring, especially in tissue flap reconstruction.
The benefits of immediate surgery are that breast skin is preserved, resulting in a more natural and better-looking result. In addition, women do not have to go without breast-shape following a mastectomy, and this can circumvent psychosocial problems that some women will encounter following the loss of breast shape. Each case varies from person to person, so it is important to consider options and be open when speaking with doctors and surgeons.
Higher Risk with Immediate Reconstruction
Olsen and her team extracted data from insurance claims across 12 states, giving the research team access to 17,239 cases in which a mastectomy was performed. They classified the mastectomies into two categories: immediate reconstruction (IR) that took place within seven days of the mastectomy, and delayed reconstruction (DR) which took place after the seven-day period. They also factored in secondary reconstruction procedures (SR) from which complications could potentially arise.
The study identified two types of complications that commonly occur in breast reconstruction procedures. The first type of complication is a surgical site infection (SSI), in which an infection sets in over the area of incision. The second type of complication is a noninfectious wound complication (NIWC) in which skin or interior tissue might not heal properly.
The study included women between the ages of 18 and 64, and included results of surgeries within a seven-year time period. There were limitations in using the data, namely, that all insurance claims used were for administrative use. This opens the door for misclassification of diagnoses, and for improper coding of SSIs and NIWCs.
Olsen and her team discovered that overall, the chances of experiencing a surgical site infection or a non-infectious wound complication were slightly higher in patients who chose immediate reconstruction than in those who chose to delay reconstruction. In addition, they identified somewhat of a snowball effect, in which those who experienced a complication during immediate reconstruction were far more likely to experience subsequent complications after secondary reconstruction procedures.
This was found to be especially true for individuals who were obese, who had diabetes, or who were smokers. In these cases, it was particularly beneficial to delay breast reconstruction procedures. Having a combination of these factors led to significantly higher chances of developing a serious wound complication.
Conclusions of the Study
The research team published the results of the study in JAMA Surgery in an online network of scientific journals. In the publication, the team wrote that “the risk for complications should be carefully balanced with the psychosocial and technical benefits of immediate reconstruction.” These benefits will vary from person to person, depending upon factors such as age and lifestyle.
The researchers go on to say that “select high-risk patients may benefit from consideration of delayed rather than immediate implant reconstruction to decrease breast complications after mastectomy.” While undergoing immediate breast reconstruction is inherently risky, this knowledge may benefit those who would ordinarily leap into immediate breast reconstruction without properly considering the risk factors involved.
Alternative treatments for breast cancer do exist that preserve breast tissue, but patients should always consider most highly the option that ensures the most effective treatment. This principle can also be extended to breast reconstruction, which may lead to an even longer battle with appearances and complications on top of an already demanding therapy and treatment.
References
https://www.sciencedaily.com/releases/2017/07/170719132311.htm
