Decisions for immediate breast reconstruction: Do surgeons make sensible choices?

Abstract

Background: Current UK national guidelines recommend reconstruction discussion for all women undergoing mastectomy for breast cancer. The decision for immediate reconstruction lies with the surgeon, based on patient's choice, comorbidities and expected post operative adjuvant treatments especially radiotherapy which may affect reconstruction outcome. The aim of our study was to review surgeons' decisions for immediate breast reconstruction and their accuracy of prediction for post mastectomy radiotherapy. Method(s): Prospectively collected 24 months data from a single oncoplastic breast unit was reviewed. All patients who had mastectomy for breast cancer with or without reconstruction were included. Reason for mastectomy, pre-operative tumour characteristics, reconstruction discussion, type of reconstruction and likelihood of postoperative radiotherapy were noted. Final outcome was the number of patients who had immediate reconstruction and needed post mastectomy radiotherapy. Result(s): Out of 173 patients who underwent mastectomy for invasive and in-situ breast cancer, 156 (90%) had a reconstruction discussion. Immediate reconstruction was offered to 130 patients and was accepted by 95 of them. Out of all immediate reconstructions, 53 (56%) were implant based and 42 (44%) had autologous reconstruction. Only 9 of these 95 patients required post-operative radiotherapy after MDT discussion. Statistical analysis showed surgeons were able to predict unlikelihood of radiotherapy in majority (90%) of immediate breast reconstruction patients (p=0.001). Conclusion(s): In a high volume breast reconstruction practice unit, we found that only a small number of our immediate breast reconstructions required post mastectomy chest wall radiotherapy. Surgeons are able to make appropriate reconstruction selection based on their predictability of radiotherapy for better-informed decision making and to potentially avoid the associated cosmetic problems.