title: Does immediate breast reconstruction using free flaps lead to delay in the administration of adjuvant chemotherapy for breast cancer?
abstract: BACKGROUND
  Immediate breast reconstruction (IBR) using Free flaps is becoming increasingly popular. However, these are complex surgical procedures with more complications and longer recovery time, which can potentially delay adjuvant treatment. Our aim is to investigate the impact of free flap IBR on the timing of adjuvant treatment.
  
  
  METHODS
  Details of all breast cancer patients undergoing mastectomy with (study group) and without (control group) free flap IBR, followed by adjuvant treatment between 2002 and 2007 were obtained. The time lapse between surgery and adjuvant therapy was calculated and the causes of delay were recorded. The results were compared between the two groups and with local and international guidelines.
  
  
  RESULTS
  Twenty-seven and 139 patients were included in the study and control group, respectively. The mean time period between surgery and commencement of adjuvant treatment for the study group was 55 days compared with 40 days for the controls. Furthermore, significantly less IBR patients received their adjuvant treatment within 6, 8 or 10 weeks after surgery in comparison to the control group. Groups appeared similar however at 12-week point. The reason for the delays was reconstruction-related surgical complications.
  
  
  CONCLUSIONS
  There is a significant delay in the commencement of adjuvant treatment after mastectomy and free flap IBR in comparison to mastectomy alone patients due to reconstruction related surgical complications. The effects of this delay on survival have not been fully investigated yet and may be significant for at least some of the patients.
authors.affiliation: Breast Unit, Guy's Hospital, London, UK. Michalis_Kontos@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Kontos
authors.forename: R S
authors.initials: RS
authors.lastname: Lewis
authors.forename: M
authors.initials: M
authors.lastname: Lüchtenborg
authors.forename: L
authors.initials: L
authors.lastname: Holmberg
authors.forename: H
authors.initials: H
authors.lastname: Hamed
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D013524:Surgical Flaps / Q000009:adverse effects; D013997:Time Factors