Earlier diagnosis and advanced treatment has made less radical breast cancer surgery feasible for many patients. Unfortunately, mastectomy and the psychological trauma of losing a breast is still what awaits many breast cancer patients. Previously it was argued that delayed breast reconstruction, or no reconstruction at all, after mastectomy would be safer than immediate reconstruction. Is this really the case? Fernandez-Frias, Aguilar and co-workers at Elche University General Hospital, Spain, addressed the issue in their recently published study in the Jan 2009 volume (Volume 208, pp 126 to 133) of the Journal of the American College of Surgeons. The study adopted a method of collective literature review and centered around the keywords mastectomy, immediate reconstruction and breast cancer. They found that most of the papers they reviewed had suggested that post-mastectomy immediate reconstruction had overall recurrence and survival rates comparable to those expected in women with the same characteristics who had not undergone mastectomy. Even in the treatment of high risk breast cancer, mastectomy followed by immediate reconstruction was seen to be a valid option.
No Scientific Evidence of a Relationship Between Immediate Reconstruction and Adjuvant Therapy
Another controversial aspect of immediate breast reconstruction following mastectomy is the need for adjuvant treatment (treatment supplementary to cancer surgery, in breast cancer, consists of hormonal therapy, chemotherapy and radiotherapy) which might have an impact on the overall outcomes. The investigators found no scientific evidence of a relationship between immediate reconstruction and hormonal therapy. Also, immediate post-mastectomy reconstruction did not appear to interfere with chemotherapy administration and did not modify overall survival and recurrence rates. With regard adjuvant radiotherapy, radiotherapy after mastectomy with immediate reconstruction might have negative effects on the final cosmetic result in women receiving reconstruction, because the acute effects of radiation lead to an increase in the incidence of local complications. In addition, immediate reconstruction might interfere with radiotherapy field of distribution, causing inadequate coverage of the chest wall or an excess of dosage to the heart and the lungs.
Tumor Size and Differentiation Has To Be Considered
Tumor factors, mainly size and grade of tumor differentiation, also have an impact on the decision making process undertaken by both physicians and patients regarding treatment of breast cancer and the use of immediate breast reconstruction.
Conclusion
Their conclusion is that immediate reconstruction after mastectomy for breast cancer appears to be a safe treatment option, well accepted by patients, that should be offered to all women irrespective of their age or tumor stage because of its cosmetic and psychosocial benefits. These benefits arguably “compensate for both the increase in incidence of post-surgical complications as compared with those in women having mastectomy but no reconstruction and the impact on adjuvant oncologic treatment, especially with regard to radiotherapy.”
Disclaimer:
Please note that the methodology adopted by this quoted study is based on a largely descriptive literature review and not a scientific meta-analysis of randomized controlled trials. Meta-analysis of randomized controlled trials is considered to offer evidence of much greater value, but is not always feasible, often related to a lack of randomized controlled trials.
Benson Yeung - General Surgeon born in the sixties, grew up in Hong Kong, won numerous writing awards in primary and secondary schools, educated in ...
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