Time to final breast reconstruction: Effect on quality of life and associated factors

Background

Breast cancer patients often undergo prolonged periods of care due to chemotherapy, radiation, and multiple breast reconstruction procedures. The time to final reconstruction (TTFR) after mastectomy can span years, during which time patients may experience reduced quality of life (QoL). However, the relationship between prolonging this interval and long-term QoL is unclear.

Methods

We analyzed a prospectively collected registry of patients who received breast reconstruction at our institution. We obtained data for patients meeting the following criteria: received breast reconstruction between 2010 and 2015; had at least 12 months of Breast-Q follow-up; and for whom TTFR was available. Patients who received final breast reconstruction on the same day as mastectomy were excluded.

Results

We identified 198 female patients. The median time to final reconstruction was 199 days. Women with a BMI of ≥35 kg/m² experienced the longest interval (936 days; p=0.001). African-American women also experienced greater delays (mean: 527 days; p=0.05). Women undergoing autologous reconstruction experienced a significantly greater delay compared to implant-based or fat grafting (325 days; p=0.02). However, this did not hold in the adjusted model. Compared to staged, women undergoing delayed reconstruction waited the longest (mean: 1269 days; p<0.001). Regarding QoL, a linear regression revealed reductions across all domains per each day of delay in final reconstruction.

Conclusion

A longer interval between mastectomy and final reconstruction may be associated with decreases in QoL outcomes. Factors including mastectomy type, reconstruction type, and patient demographics may impact this interval. These factors are worth considering when discussing reconstruction options.