Complications to surgery have been implicated in recurrence in many cancer forms. Methods for breast reconstruction after mastectomy vary substantially in magnitude of surgical trauma. We have previously reported an impact of delayed reconstructive surgery on the relapse dynamics in breast cancer patients. In the current study, our aim was to determine the rate of complications after delayed breast reconstruction, and explore a potential link to oncologic outcome between these events as well as perioperative factors such as use of LMWH.
The study population consists of all patients who had delayed breast reconstruction at Haukeland University Hospital after mastectomy for breast cancer between 1977 and 2007, n = 312. Complications, relapses and deaths were registered from patients’ records. Survival was evaluated by the Kaplan-Meier method.
41% received implant surgery alone, the remaining had autologous reconstructions (28%), or combinations of implant and contralateral reduction (31%). In total 28% experienced complications > = grade 2 (Common Terminology Criteria for Adverse Events, CTCAE version 4.0). In the group receiving autologous flap reconstructions 56% had complications grade > =2. Patients with complications grade > =2 demonstrated a bimodal relapse patterns with a near doubling of the first peak at 18 months, compared to patients with none or minor (grade 1) complications. Overweight or obesity at the time of reconstruction was associated with an increase in relapses the first 18 months after reconstruction, but not with increased complications. Surprisingly, perioperative anticoagulation with LMWH was associated with reduced relapse-free survival.
In our material, complications were significantly more prevalent in patients undergoing extensive reconstructive procedures. This did not result in significantly reduced breast cancer specific or overall survival. The relapse dynamics, however, were affected. This suggests an accelerating effect on the escape of micrometastases from tumor dormancy as a result from an additional inflammatory response induced by the complication.
University of Bergen.
Has not received any funding.
S.A. Jensen: Consult cosmetic surgery: Sørlandet Privatsykehus AS. All other authors have declared no conflicts of interest.