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2. An investigation into the pathophysiology of breast cancer-related lymphoedema

Author

Bains, Salena Raminder Ramanjeet Kaur and Purushotham, Anand David

Subjects
616.99
Abstract

Breast cancer-related lymphoedema (BCRL) is a chronic condition with associated physical and psychological sequelae. BCRL affects up to 25% of breast cancer patients, yet the aetiology is incompletely understood. The work described within this thesis will help further advance the understanding of the pathophysiology of BCRL, with a focus on whether patients are predisposed to developing BCRL. Studies were conducted using qualitative and quantitative lymphoscintigraphy to assess the lymphatic system in breast cancer patients. The first study investigated muscle lymph flow in the upper limb. Lymphatic clearance rates were measured to investigate whether there was an abnormality in lymph flow prior to axillary lymph node surgery in patients who subsequently developed BCRL. Secondly, patients were assessed for the presence of upper limb lymphovenous communications to determine if these acted as a protective mechanism against the development of BCRL. Finally, in order to determine if there was a global dysfunction of the lymphatic system in patients previously treated for breast cancer, lower limb lymphatic function was assessed. The first study demonstrated that those who went on to develop BCRL had a higher pre-operative muscle lymph flow compared with those who did not, indicating an underlying constitutional difference. The second study showed evidence of the presence of lymphovenous communications in several breast cancer patients studied, however the numbers were too small to show any correlation with the development of BCRL. The final study showed that patients with BCRL had significantly impaired lower limb lymph flow compared with non-BCRL patients. Intriguingly, several non-BCRL patients were also found to have impaired lower lymph flow, raising the question of whether systemic treatment with chemotherapy was a significant contributory factor to this phenomenon. In conclusion, these studies add evidence in support of the hypothesis that constitutional factors contribute to the development of BCRL.

Published
2015

3. Current use of drains and management of seroma following mastectomy and axillary surgery: results of a United Kingdom national practice survey.

Author

Fairhurst, K., Roberts, K., Fairbrother, P., Potter, S., on behalf of the Diamond Study Collaborative, Abbott, Nick, Achuthan, Raj, Ahmed, Goran, Ainsworth, Rachel, Arthur, Laura, Bains, Salena, Barber, Zoe, Batt, Jeremy, Bell, Ashleigh, Carter, Jane, Chambers, Alice, Conway, Anna, Courtney, Carol-Ann, Daltrey, Ian, and Daoud, Raouf

Abstract

Purpose: Up to 40% of the 56,000 women diagnosed with breast cancer each year in the UK undergo mastectomy. Seroma formation following surgery is common, may delay wound healing, and be uncomfortable or delay the start of adjuvant treatment. Multiple strategies to reduce seroma formation include surgical drains, flap fixation and external compression exist but evidence to support best practice is lacking. We aimed to survey UK breast surgeons to determine current practice to inform the feasibility of undertaking a future trial. Methods: An online survey was developed and circulated to UK breast surgeons via professional and trainee associations and social media to explore current attitudes to drain use and management of post-operative seroma. Simple descriptive statistics were used to summarise the results. Results: The majority of surgeons (82/97, 85%) reported using drains either routinely (38, 39%) or in certain circumstances (44, 45%). Other methods for reducing seroma such as flap fixation were less commonly used. Wide variation was reported in the assessment and management of post-operative seromas. Over half (47/91, 52%) of respondents felt there was some uncertainty about drain use after mastectomy and axillary surgery and two-thirds (59/91, 65%) felt that a trial evaluating the use of drains vs no drains after simple breast cancer surgery was needed. Conclusions: There is a need for a large-scale UK-based RCT to determine if, when and in whom drains are necessary following mastectomy and axillary surgery. This work will inform the design and conduct of a future trial. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

Author

Potter, S, primary, Trickey, A, additional, Rattay, T, additional, O'Connell, R L, additional, Dave, R, additional, Baker, E, additional, Whisker, L, additional, Skillman, J, additional, Gardiner, M D, additional, Macmillan, R D, additional, Holcombe, C, additional, Potter, S, additional, Barnes, Nicola L P, additional, Blazeby, Jane, additional, Conroy, Elizabeth, additional, Dave, Rajiv V, additional, Gardiner, Matthew D, additional, Harnett, Adrian, additional, Holcombe, Chris, additional, Potter, Shelley, additional, Rattay, Tim, additional, Skillman, Joanna, additional, Williamson, Paula, additional, Achuthan, Rajgopal, additional, Aggarwal, Shweta, additional, Baker, Elizabeth, additional, Basu, Naren, additional, Brock, Lisa, additional, Fairbrother, Patricia, additional, Ives, Charlotte, additional, Jain, Abhilash, additional, Kim, Baek, additional, Macmillan, R Douglas, additional, Murphy, John, additional, Remoundos, Dennis, additional, Sutton, Richard, additional, Trickey, Adam, additional, Turton, Philip, additional, Williams, Kathryn, additional, Curnier, Alain, additional, Tadros, Amir, additional, Depasquale, Ivan, additional, Fuller, Mairi, additional, Bourne, Roger, additional, Heys, Steven, additional, Hamo, Ishrak, additional, Aloraifi, Fatima, additional, Fopp, Laura, additional, Bali, Radhika, additional, Bache, Sarah, additional, Benyon, Sarah L, additional, Irwin, Michael S, additional, Agrawal, Amit, additional, Malata, Charles M, additional, Murphy, Claire, additional, Misky, Adam, additional, Chicken, Dennis Wayne, additional, Abdullah, Nassreen, additional, Hill, Arnold D K, additional, Cullinane, Carolyn, additional, Irwin, Gareth, additional, McIntosh, Stuart A, additional, Refsum, Sigi, additional, Sloan, Samantha, additional, Mallon, Peter, additional, Sirianni, Chiara, additional, Khattak, Ilyas, additional, Nagachandra, Geerthan, additional, Kiruparan, Pasupathy, additional, Debanth, Debasish, additional, Davey, Simon, additional, Curran, Terry-Ann, additional, Svenning, Matilda, additional, Govindarajulu, Sasirekha, additional, Rayter, Zenon, additional, Ainsworth, Rachel, additional, Cawthorn, Simon, additional, Sahu, Ajay, additional, Wilson, Sherif, additional, Prousskaia, Elena, additional, Accurso, Antonello, additional, Rocco, Nicola, additional, Di Micco, Rosa, additional, Limite, Gennaro, additional, Ceccarino, Raffaele, additional, Liccardo, Raffaele, additional, Coco, Guido, additional, Nizamoglu, Metin, additional, Morgan, Mary, additional, Ramakrishnan, Venkat, additional, Catanuto, Giuseppe, additional, Wilkins, Alex, additional, McManus, Penelope, additional, Kneeshaw, Peter, additional, Grover, Kartikae, additional, Mahapatra, Tapan, additional, Wooler, Brendan, additional, Elahi, Bilal, additional, Ihsan, Naila, additional, Bucknor, Alexandra, additional, Reissis, Dimitris, additional, Hunter, Judith, additional, Wood, Simon, additional, Jallali, Navid, additional, Henry, Francis P, additional, Verjee, Liaquat S, additional, Lee, Jason, additional, Khan, Shazia M, additional, Azmy, Iman, additional, Massey, Julia, additional, Hollywood, Ciaran, additional, Oluwajana, Michael, additional, Bathla, Sonia, additional, Seward, Joanna, additional, Harding-MacKean, Claudia, additional, Lane, Risha, additional, Murali, Kothandaraman, additional, Biswas, Bashishta, additional, Trapszo, Pawel, additional, Seetharam, Seema, additional, Kennedy, Katy, additional, Alder, Louise, additional, Graja, Tomasz, additional, Amin, Khalid, additional, Kokan, Jalal, additional, Roshanlall, Chandeena, additional, Gill, Emma, additional, Kulkarni, Dhananjay, additional, Dixon, J M, additional, Young, Oliver, additional, Saleem, Talha, additional, Biddle, M, additional, Kearns, Marie, additional, Weiler-Mithoff, Eva, additional, Chew, Ben, additional, Malyon, Andy, additional, Scott, John, additional, McGill, David, additional, Mackay, Iain, additional, Bains, Salena, additional, Barrows, Sara, additional, Pilgrim, Simon, additional, Shokuhi, Sheila, additional, Lambert, Kelly, additional, Kenny, Frances, additional, Valassiadou, Kalliope, additional, Kaushik, Monika, additional, Krupa, Jaroslaw, additional, Dragoumis, Dimitris, additional, Lampropoulos, Pavlos, additional, Moss, Sarah, additional, Khalil, Haitham, additional, Haq, Anwar, additional, Balasubramanian, Balapathiran, additional, Charalampoudis, Petros, additional, Hamed, Hisham, additional, Kothari, Ashutosh, additional, Kovacs, Tibor, additional, Douek, Michael, additional, Mehmood, Iftikhar, additional, Ray, Biswajit, additional, Adelekan, Matthew, additional, Humphreys, Laura, additional, Tayeh, Salim, additional, Choy, Christina, additional, Parvanta, Laila, additional, Michieletto, Silvia, additional, Saibene, Tania, additional, O'Brien, James, additional, Down, Sue, additional, Downey, Sarah, additional, Pereira, Jerome, additional, Sami, A S, additional, Gvaramadze, Anzors, additional, Jibril, Jibril A, additional, Thekkinkattil, Dinesh, additional, Udayasankar, S, additional, Khawaja, Saira, additional, Shariaha, Yousef, additional, Holt, Simon, additional, James, Ruth, additional, Rizki, Hirah, additional, Kirkpatrick, Katharine, additional, Ravichandran, Duraisamy, additional, Shrestha, Deepak, additional, Barua, Ellora, additional, Akolekar, Deepika, additional, Hamad, Ahmed, additional, Kleidi, Eleftheria, additional, Hignett, Susan, additional, Pope, Vanessa, additional, Naseem, Salma, additional, Isherwood, Jennifer, additional, Soulsby, Rachel, additional, Taylor, Amanda, additional, Chin, Kian, additional, Nguyen, Dai, additional, Guest, Francesca, additional, Thorne, Amanda, additional, Lefemine, Valentina, additional, Kirchhoff, Chris, additional, Murphy, Declan C, additional, Lo, Michelle, additional, Harcourt, Ruth, additional, Pain, Simon J, additional, Hussien, Maged I, additional, Zechmeister, Katalin, additional, Sassoon, E M, additional, Figus, Andrea, additional, Haywood, Richard M, additional, Ali, Rozina, additional, Alexander, Susanna, additional, Geropantas, Konstantinos, additional, Epurescu, Daniel, additional, Lewis, Rebecca, additional, Fafemi, Oladapo, additional, Gahir, Jasdeep, additional, Gandamihardja, Tasha, additional, Kelsall, Jennett, additional, Muhibullah, Nazli, additional, Otieno, Charlene, additional, Mazari, Fayyaz, additional, Dauria, Marta, additional, Whisker, Lisa, additional, Macmillan, Douglas, additional, Gutteridge, Eleanor, additional, Rasheed, Tuabin, additional, Khout, Hazem, additional, Asgeirsson, Kristjan, additional, McCulley, Stephen, additional, Mariniello, Maria Donatella, additional, Roncella, Manuela, additional, Ghilli, Matteo, additional, Colizzi, Livio, additional, Rossetti, Elena, additional, Marzia, Lo Russo, additional, Fustaino, Loredana, additional, Li, Alessandro Quattrini, additional, Harvey, Kate L, additional, Windle, Rebecca, additional, Remoundos, Dionysios Dennis, additional, Roy, Pankaj, additional, MacLean, Gael, additional, Adwani, Asha, additional, Popa, Elena, additional, Goh, Steven, additional, Shetty, Geeta, additional, Clark, Sarah, additional, Bernaudo, Lorenzo, additional, Agrawal, Avi, additional, Mansfield, Lucy, additional, Tebbal, Sally, additional, Patel, Ashraf, additional, Grassi, Veronica, additional, Pujji, Ojas, additional, Hamnett, Kathryn, additional, Granger, Emily, additional, Durbar, Michael, additional, Pikoulas, Panagiotis, additional, Garnsey, Clare, additional, Walker, Philip, additional, Vollermere, Angela J, additional, Michalakis, Ioannis, additional, Jones, Robin, additional, Youssef, Mina, additional, Masood, Mohammad, additional, Dunn, Julie, additional, Olsen, Sisse, additional, Ferguson, Douglas, additional, Tillett, Rachel, additional, Allan, Anna, additional, Woollard, Alex, additional, Canny, Rebecca, additional, Woollard, Alexander, additional, Mosahebi, Afshin, additional, Hamilton, Stephen, additional, Chana, Jagdeep, additional, Sojitra, Nilesh, additional, Younis, Ibby, additional, Rainsbury, Dick, additional, Chand, Natalie, additional, Kalles, Vasileios, additional, Stebbing, Anne, additional, Harris, Kevin, additional, Laws, Siobhan, additional, Tansley, Anne, additional, Mitchell, Geraldine, additional, de Sousa, Emma, additional, Henderson, Julia, additional, Chandrashekar, Mysore, additional, Pereira, Bernadette, additional, Constantinou, Chloe, additional, Elfadl, Dalia, additional, Irakleidis, Foivos, additional, Hernan, Izaro, additional, Byrne, Miriam, additional, O'Connell, Rachel, additional, Rusby, Jennifer, additional, Barry, Peter, additional, Krupa, Katerine, additional, Allum, William, additional, MacNeill, Fiona, additional, Roche, Nicola, additional, Gui, Gerald, additional, Ramsey, Kelvin, additional, Harris, Paul, additional, James, Stuart, additional, McIntosh, Jamie, additional, Laurence, Nicola, additional, MacLennan, Louise, additional, Milligan, Robert, additional, Cain, Henry, additional, Critchley, Adam, additional, O'Donoghue, Joe, additional, Kalra, Loraine, additional, Collis, Nick, additional, Weston-Petrides, Gina, additional, Fiddes, Roanne, additional, Brown, Victoria, additional, Aertssen, Anna, additional, Slade-Sharman, Diana, additional, Khan, Mansoor, additional, McGuiness, Caroline, additional, Amorosi, Vittoria, additional, di Pompeo Fabio, Santanelli, additional, Exarchos, Georgios, additional, Jiwa, Natasha, additional, Hu, Jennifer, additional, Ledwidge, Serena, additional, Johnson, Laura, additional, Peel, Anthony, additional, Dhooma, Naseem, additional, Farrell, Eric, additional, Devane, Liam, additional, Tevlin, Ruth, additional, McDermott, Enda, additional, Prichard, Ruth, additional, Evoy, Denis, additional, Rothwell, Jane, additional, Geraghty, James, additional, Morrison, Colin, additional, Lawlor, Catriona, additional, Langlands, Fiona, additional, Taylor, Lauren, additional, Achuthan, Raj, additional, Horgan, Kieran, additional, Mckenzie, Shireen, additional, Hogan, Brian, additional, Lansdown, Mark, additional, Navin, Channegowda, additional, Sherwin, Liz, additional, Mortimer, Caroline, additional, Garg, Neeraj, additional, Adam, Rahma, additional, Arif, Tahera, additional, Kryjak, Zbigniew, additional, Ali, Deedar, additional, Sowdi, Ravi, additional, Fage, Elena, additional, Mylvaganam, Senthurun, additional, Matey, Pilar, additional, Vidya, Raghavan, additional, Sircar, Tapan, additional, Asaad, Oubida, additional, Bhaskar, Pud, additional, Dordea, Matei, additional, Chrysafi, Ada, additional, McCartan, Damian, additional, Dave, Rajiv, additional, Foster, Rachel, additional, Wilson, Rebecca, additional, Okwemba, Sylvia, additional, Majeed, Yousef, additional, O'Brien, Ciara, additional, Mathen, Vinod, additional, Barnes, Nicola, additional, Gandhi, Ashu, additional, Harvey, James, additional, Kirwan, Cliona C, additional, Johnson, Richard, additional, Patel, Krupali, additional, Ribas, Maria Dalmau, additional, Vigneswaran, Natali, additional, Challoner, Tom, additional, Park, Alan, additional, Rizkalla, Maged, additional, Tomlins, Abigail, additional, McEvoy, Kat, additional, Jafferbhoy, Sadaf, additional, Soumian, Soni, additional, Narayanan, Sankaran, additional, Kirby, Robert, additional, Bajrusevic, Sladana, additional, Maalo, Joseph, additional, Charalambous, Michalis, additional, Lai, Lee Min, additional, Chong, Kelvin, additional, Thomson, Simon, additional, Monib, Sherif, additional, Chagla, Leena, additional, Audisio, Riccardo, additional, Taghizadeh, Rieka, additional, Iqbal, Azhar, additional, James, Karen, additional, Callaghan, Maria, additional, Poonawala, Shabbir, additional, Lund, Jonathan, additional, Vinayagam, Raman, additional, Thrush, Steven, additional, Thomas, Rachel Bright, additional, Mullan, Michelle, additional, Taylor, Jevan, additional, Yoshimura, Ryo, additional, Mathew, Tom, additional, Jones, Ben Mancey, additional, Munot, Kailas, additional, Nasr, Rana, additional, Piper, Jenny, additional, El-Sharief, Deena, additional, Mustafa, Mohammed, additional, MacLeod, Caitlin, additional, Smyth, Elizabeth, additional, Saeed, Nina, additional, Masannat, Yazan, additional, Mohd-Amin, Amir Tan, additional, Sloan, Sam, additional, McIntosh, Stuart, additional, Ibrahim, Abdulla, additional, Rathinaezhil, Rathi, additional, Khalifa, Eiman, additional, McManus, Penny, additional, Leeper, Alexander, additional, McIlhenny, Jennifer, additional, Mansell, James, additional, Ogsto, Keith, additional, Romics, Laszlo, additional, Shokuhi, Shelia, additional, Lee, Xiang Wei Jonathan, additional, Al-Allak, Asmaa, additional, Fowler, Clare, additional, Massey, Eleanore, additional, Court, Fiona, additional, Hunt, Richard, additional, Vestey, Sarah, additional, Elgammal, Mohsen, additional, Noshirwani, Arish, additional, Arif, Tehera, additional, Syed, Farah H, additional, Safdar, Gazalla, additional, El-Abbar, Mohammed, additional, Hogg, Fiona, additional, McGee, Pauline, additional, Pitsinis, Vassilis, additional, Smith, Jenny, additional, Makkiyah, Sundus, additional, Mustafa, Syed, additional, Photiou, Dana, additional, Gutteridge, Ellie, additional, Oni, Georgette, additional, Hallam, Kelly, additional, Asgeirron, Kristjan, additional, D'Auria, Marta, additional, Al-zubaidi, Samim, additional, Bailey, James, additional, Tenovici, Alexandra, additional, Remoundos, Dionysios-Dennis, additional, Chaidos, Nikos, additional, Predescu, Oana, additional, Rezulski, Jan, additional, Abdullah, Tholkifl, additional, Udayasankar, Sujatha, additional, Talbot, Adam, additional, Singh, Jagdeep, additional, Smith, Amy, additional, Volleamere, Angela, additional, Dean, Sarah, additional, Peiris, Lashan, additional, Sjokvist, Olivia, additional, De Sousa, Emma, additional, Micha, Aikaterini, additional, Godden, Amy, additional, Krupa, Katherine, additional, Henton, John, additional, Bennett, Ruth, additional, Nicholson, Stewart, additional, Paolini, Guido, additional, Renzi, Luca Francesco, additional, Di Pompeo, Santanelli, additional, Ria, Vitto, additional, Lewis, Rebecca S, additional, Hadad, Sirwan, additional, Sharma, Anup, additional, Toomey, Delia, additional, Banerjee, Dibyesh, additional, Tang, Sarah Shuk Kay, additional, McKenzie, Shireen, additional, Ahmad, Tanvir, additional, Williams, Kate, additional, Absar, Mohammed, additional, Nasir, Nabila, additional, Rychlik, Igor Jerzy, additional, Darragh, Lynn, additional, Johnston, Ruth, additional, Kirk, Stephen, additional, Rees-Lee, Jacqueline, additional, Green, Michael, additional, Sharma, Abhishek, additional, Choong, Jia, additional, Ullah, Zaker, additional, Koshy, Ommen, additional, Kiernan, Tamara, additional, Bhojwani, Ajay Ashok, additional, Bright-Thomas, Rachel, additional, Byrne, Ged, additional, Ibrahim, Ibrahim, additional, Highton, Lyndsey, additional, Morris, Owen, additional, Chatterjee, Sumohan, additional, Kirwan, Cliona, additional, Mancey-Jones, Ben, additional, El Sharief, Denna, additional, and Frame, Richard, additional

Published
2020
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8. The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Author

O'Connell, Rachel L, Rattay, Tim, Dave, Rajiv V, Trickey, Adam, Skillman, Joanna, Barnes, Nicola LP, Gardiner, Matthew, Harnett, Adrian, Potter, Shelley, Holcombe, Chris, Blazeby, Jane, Conroy, Elizabeth, O'Brien, Ciara, Williamson, Paula, Curnier, Alain, Tadros, Amir, Depasquale, Ivan, Masannat, Yazan A, Smyth, Elizabeth, Fuller, Mairi, Bourne, Roger, Heys, Steven, Hamo, Ishrak, Aloraifi, Fatima, Fopp, Laura, Bali, Radhika, Bache, Sarah, Benyon, Sarah L, Irwin, Michael S, Agrawal, Amit, Malata, Charles M, Murphy, Claire, Misky, Adam, Chicken, Dennis Wayne, Abdullah, Nassreen, Hill, Arnold DK, Cullinane, Carolyn, Irwin, Gareth, McIntosh, Stuart A, Refsum, Sigi, Sloan, Samantha, Mallon, Peter, Sirianni, Chiara, Khattak, Ilyas, Nagachandra, Geerthan, Kiruparan, Pasupathy, Debanth, Debasish, Davey, Simon, Curran, Terry-Ann, Svenning, Matilda, Govindarajulu, Sasirekha, Rayter, Zenon, Ainsworth, Rachel, Cawthorn, Simon, Sahu, Ajay, Wilson, Sherif, Prousskaia, Elena, Accurso, Antonello, Rocco, Nicola, Di Micco, Rosa, Limite, Gennaro, Ceccarino, Raffaele, Liccardo, Raffaele, Coco, Guido, Nizamoglu, Metin, Morgan, Mary, Ramakrishnan, Venkat, Catanuto, Giuseppe, Wilkins, Alex, McManus, Penelope, Kneeshaw, Peter, Grover, Kartikae, Mahapatra, Tapan, Wooler, Brendan, Elahi, Bilal, Ihsan, Naila, Bucknor, Alexandra, Reissis, Dimitris, Hunter, Judith, Wood, Simon, Jallali, Navid, Henry, Francis P, Verjee, Liaquat S, Lee, Jason, Khan, Shazia M, Azmy, Iman, Massey, Julia, Hollywood, Ciaran, Oluwajana, Michael, Bathla, Sonia, Seward, Joanna, Harding-MacKean, Claudia, Lane, Risha, Murali, Kothandaraman, Biswas, Bashishta, Trapszo, Pawel, Seetharam, Seema, Kennedy, Katy, Alder, Louise, Graja, Tomasz, Amin, Khalid, Kokan, Jalal, Roshanlall, Chandeena, Gill, Emma, Kulkarni, Dhananjay, Dixon, JM, Young, Oliver, Saleem, Talha, Biddle, M, Kearns, Marie, Weiler-Mithoff, Eva, Chew, Ben, Malyon, Andy, Scott, John, McGill, David, Mackay, Iain, Bains, Salena, Barrows, Sara, Pilgrim, Simon, Shokuhi, Sheila, Lambert, Kelly, Kenny, Frances, Valassiadou, Kalliope, Kaushik, Monika, Krupa, Jaroslaw, Dragoumis, Dimitris, Ain, Quratul, Lampropoulos, Pavlos, Moss, Sarah, Khalil, Haitham, Haq, Anwar, Balasubramanian, Balapathiran, Charalampou-Dis, Petros, Hamed, Hisham, Kothari, Ashutosh, Kovacs, Tibor, Douek, Michael, Mehmood, Iftikhar, Ray, Biswajit, Adelekan, Matthew, Humphreys, Laura, Tayeh, Salim, Choy, Christina, Parvanta, Laila, Michieletto, Silvia, Saibene, Tania, O'Brien, James, Down, Sue, Downey, Sarah, Pereira, Jerome, Sami, AS, Gvaramadze, Anzors, Jibril, Jibril A, Thekkinkattil, Dinesh, Udayasankar, S, Khawaja, Saira, Shariaha, Yousef, Holt, Simon, James, Ruth, Rizki, Hirah, Kirkpatrick, Katharine, Ravichandran, Duraisamy, Shrestha, Deepak, Barua, Ellora, Akolekar, Deepika, Hamad, Ahmed, Kleidi, Eleftheria, Hignett, Susan, Pope, Vanessa, Naseem, Salma, Isherwood, Jennifer, Soulsby, Rachel, Taylor, Amanda, Chin, Kian, Nguyen, Dai, Guest, Francesca, Thorne, Amanda, Kirchhoff, Chris, Murphy, Declan C, Lo, Michelle, Harcourt, Ruth, Pain, Simon J, Hussien, Maged I, Zechmeister, Katalin, Sassoon, EM, Figus, Andrea, Haywood, Richard M, Ali, Rozina, Alexander, Susanna, Geropantas, Konstantinos, Epurescu, Daniel, Lewis, Rebecca, Fafemi, Oladapo, Gahir, Jasdeep, Gandamihardja, Tasha, Kelsall, Jennett, Muhibullah, Nazli, Otieno, Charlene, Mazari, Fayyaz, Dauria, Marta, Whisker, Lisa, Macmillan, Douglas, Gutteridge, Eleanor, Rasheed, Tuabin, Khout, Hazem, Asgeirsson, Kristjan, McCulley, Stephen, Mariniello, Maria Donatella, Roncella, Manuela, Ghilli, Matteo, Colizzi, Livio, Rossetti, Elena, Marzia, Lo Russo, Fustaino, Loredana, Li, Alessandro Quattrini, Harvey, Kate L, Windle, Rebecca, Remoundos, Dionysios Dennis, Roy, Pankaj, MacLean, Gael, Adwani, Asha, Popa, Elena, Goh, Steven, Shetty, Geeta, Clark, Sarah, Bernaudo, Lorenzo, Agrawal, Avi, Mansfield, Lucy, Tebbal, Sally, Patel, Ashraf, Grassi, Veronica, Pujji, Ojas, Hamnett, Kathryn, Basu, Naren, Granger, Emily, Durbar, Michael, Pikoulas, Panagiotis, Garnsey, Clare, Walker, Philip, Vollermere, Angela J, Michalakis, Ioannis, Jones, Robin, Youssef, Mina, Ives, Charlotte, Masood, Mohammad, Dunn, Julie, Olsen, Sisse, Ferguson, Douglas, Tillett, Rachel, Allan, Anna, Woollard, Alex, Canny, Rebecca, Woollard, Alexander, Mosahebi, Afshin, Hamilton, Stephen, Ghali, Shadi, Marsh, Daniel, Chana, Jagdeep, Sojitra, Nilesh, Younis, Ibby, Rainsbury, Dick, Chand, Natalie, Kalles, Vasileios, Stebbing, Anne, Harris, Kevin, Laws, Siobhan, Tansley, Anne, Mitchell, Geraldine, de Sousa, Emma, Henderson, Julia, Chandrashekar, Mysore, Pereira, Bernadette, Constantinou, Chloe, Elfadl, Dalia, Irakleidis, Foivos, Hernan, Izaro, Byrne, Miriam, To, Natalie, O'Connell, Rachel, Rusby, Jennifer, Barry, Peter, Krupa, Katerine, Allum, William, MacNeill, Fiona, Roche, Nicola, Gui, Gerald, Ramsey, Kelvin, Harris, Paul, James, Stuart, Power, Kieran, Sutton, Richard, McIntosh, Jamie, Laurence, Nicola, MacLennan, Louise, Milligan, Robert, Cain, Henry, Critchley, Adam, O'Donoghue, Joe, Kalra, Loraine, Collis, Nick, Weston-Petrides, Gina, Fiddes, Roanne, Brown, Victoria, Aertssen, Anna, Slade-Sharman, Diana, Khan, Mansoor, McGuiness, Caroline, Amorosi, Vittoria, Fabio, Santanelli di Pompeo, Exarchos, Georgios, Jiwa, Natasha, Hu, Jennifer, Ledwidge, Serena, Johnson, Laura, Peel, Anthony, Dhooma, Naseem, Farrell, Eric, Devane, Liam, Tevlin, Ruth, McDermott, Enda, Prichard, Ruth, Evoy, Denis, Rothwell, Jane, Geraghty, James, Morrison, Colin, Lawlor, Catriona, Langlands, Fiona, Taylor, Lauren, Turton, Philip, Achuthan, Raj, Horgan, Kieran, Mckenzie, Shireen, Hogan, Brian, Lansdown, Mark, Navin, Channegowda, Sherwin, Liz, Mortimer, Caroline, Garg, Neeraj, Adam, Rahma, Arif, Tahera, Kryjak, Zbigniew, Ali, Deedar, Sowdi, Ravi, Fage, Elena, Mylvaganam, Senthurun, Matey, Pilar, Vidya, Raghavan, Sircar, Tapan, Asaad, Oubida, Bhaskar, Pud, Dordea, Matei, Chrysafi, Ada, McCartan, Damian, Dave, Rajiv, Foster, Rachel, Wilson, Rebecca, Okwemba, Sylvia, Majeed, Yousef, Mathen, Vinod, Murphy, John, Barnes, Nicola, Gandhi, Ashu, Harvey, James, Kirwan, Cliona C, Johnson, Richard, Patel, Krupali, Ribas, Maria Dalmau, Vigneswaran, Natali, Challoner, Tom, Park, Alan, Rizkalla, Maged, Tomlins, Abigail, McEvoy, Kat, Jafferbhoy, Sadaf, Soumian, Soni, Narayanan, Sankaran, Kirby, Robert, Bajrusevic, Sladana, Maalo, Joseph, Charalambous, Michalis, Lai, Lee Min, Chong, Kelvin, Thomson, Simon, Monib, Sherif, Chagla, Leena, Audisio, Riccardo, Taghizadeh, Rieka, Iqbal, Azhar, James, Karen, Callaghan, Maria, Poonawala, Shabbir, Lund, Jonathan, Vinayagam, Raman, Thrush, Steven, Thomas, Rachel Bright, Mullan, Michelle, Taylor, Jevan, Yoshimura, Ryo, Mathew, Tom, Jones, Ben Mancey, Munot, Kailas, Nasr, Rana, Piper, Jenny, El-Sharief, Deena, Mustafa, Mohammed, Dumitru, Dorin, Christopoulos, Petros, O'Leary, Peter, Athanasiou, Irene, Johns, Neil, Mehta, Disha, Bibi, Saira, Syed, Farah, Koris, Jacob, Healy, Samuel, Shanks, Lindsay, Oliver, James, Bucata, Claudiu, Clarke, Natalie, Bignell, Kym, Akerlund, Malin, Brock, Lisa, Hallam, Kelly, Howes, Rachel, Armstrong, Alexander, Sethu, Claire, Zeidan, Bashar, Sjokvist, Olivia, Tasoulis, Marios, Sundaramoorthy, Souganthy, Harris, Chad, Wintrip, Dorothy, Lymperopoulos, N, Jain, Yogesh, Balata, Safa Ahmed, Grp, iBRA-2 Steering, and Collab, Breast Reconstruction Res

Subjects
Adult, Cancer Research, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Mammaplasty, trainee collaboratives, Breast Neoplasms, Article, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Breast cancer, breast cancer, Adjuvant therapy, cohort study, Medicine, Humans, Prospective Studies, Prospective cohort study, Mastectomy, Aged, Cancer, Aged, 80 and over, Manchester Cancer Research Centre, business.industry, ResearchInstitutes_Networks_Beacons/mcrc, adjuvant therapy, immediate breast reconstruction, Middle Aged, medicine.disease, Surgery, Radiation therapy, Oncology, Centre for Surgical Research, Chemotherapy, Adjuvant, Outcomes research, 030220 oncology & carcinogenesis, Surgical oncology, Female, Breast reconstruction, business, Complication, Cohort study
Abstract

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy.Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored.Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays.Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients.

Published
2019

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