Influence of Neoadjuvant Chemotherapy on Outcomes of Immediate Breast Reconstruction
- 1 July 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 126 (1), 1-11
- https://doi.org/10.1097/prs.0b013e3181da8699
Abstract
Immediate breast reconstruction following neoadjuvant chemotherapy raises concerns about increased perioperative complications and has the potential to delay planned adjuvant radiotherapy. This study examined the effect of neoadjuvant chemotherapy on reconstructive outcomes and the commencement of postoperative radiotherapy. A retrospective review of a single surgeon's immediate breast reconstructions performed from 2000 to 2007 was undertaken. The recipients of neoadjuvant chemotherapy were compared with nonrecipients (controls). One hundred seventy-one patients underwent 198 immediate breast reconstructions comprising 64 free tissue transfers, 74 pedicled flaps (latissimus dorsi and transverse rectus abdominis musculocutaneous), and 60 implant-only procedures. Fifty-three patients (31 percent), with a mean age of 47.8 years (range, 29 to 68 years), received neoadjuvant chemotherapy before mastectomy and reconstruction (58 reconstructions; 91 percent with flaps). The control group consisted of 118 patients (140 reconstructions; 61 percent with flaps) with a mean age of 50.4 years (range, 29 to 69 years), making them older (p = 0.08). The failed reconstruction rate was 2 percent (one of 58) for the neoadjuvant group and 2 percent (three of 140) for the control group, whereas the reoperation rates for major complications were 9 percent (five of 58) and 9 percent (13 of 140), respectively. Minor complications occurred in 10 percent (six of 58) of neoadjuvant reconstructions versus 6 percent (nine of 140) of controls (p = 0.380). Three-quarters of neoadjuvant patients received postoperative radiotherapy, compared with only a quarter of the controls. The commencement of radiotherapy was delayed in 10 percent (four of 39) of the chemotherapy recipients versus 11 percent (three of 28) of controls (p = 1.00). In this series, neoadjuvant chemotherapy did not appear to increase the risk of major surgical complications following mastectomy and immediate breast reconstruction or inordinately delay the institution of adjuvant radiotherapy.Keywords
This publication has 47 references indexed in Scilit:
- Effects of Radiation Therapy on Pedicled Transverse Rectus Abdominis Myocutaneous Flap Breast ReconstructionAnnals of Plastic Surgery, 2008
- Preoperative Chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27Journal of Clinical Oncology, 2008
- Complications after Microvascular Breast Reconstruction: Experience with 1195 FlapsPlastic and Reconstructive Surgery, 2006
- The surgical and oncological safety of immediate breast reconstructionEuropean Journal of Surgical Oncology, 2004
- International Expert Panel on the Use of Primary (Preoperative) Systemic Treatment of Operable Breast Cancer: Review and RecommendationsJournal of Clinical Oncology, 2003
- Recurrence following Treatment of Ductal Carcinoma in Situ with Skin-Sparing Mastectomy and Immediate Breast ReconstructionPlastic and Reconstructive Surgery, 2003
- Immediate breast reconstruction after mastectomy for cancerEuropean Journal of Surgical Oncology, 1999
- The Influence of Margin Width on Local Control of Ductal Carcinoma in Situ of the BreastNew England Journal of Medicine, 1999
- Skin-sparing mastectomy with immediate breast reconstruction: The M. D. Anderson cancer center experienceAnnals of Surgical Oncology, 1996
- Neoadjuvant chemotherapy in operable breast cancerEuropean Journal of Cancer and Clinical Oncology, 1991