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The Impact of Neoadjuvant Chemotherapy on Implant-Based Breast Reconstruction Outcomes
Minji Kim
*, Joshua Barnett, Whitney Lane, Danielle Olla, Lillian A. Boe, Carrie S. Stern, Jonas Nelson, Babak J. Mehrara
Memorial Sloan Kettering, New York City, NY
Background: Neoadjuvant chemotherapy (NACT) is commonly used for treatment of locally advanced breast cancer. The purpose of this study was to evaluate the risk of complications in patients treated with NACT and immediate tissue expander (TE) reconstruction.
Method: All female patients who underwent mastectomy followed by TE placement between January 2017 and December 2022 were reviewed. Patients who were treated with immediate TE reconstruction and receipt of NACT were compared with those treated with TE insertion without chemotherapy. Complications examined included cellulitis/infection, seroma, hematoma, mastectomy skin flap (MSFN), and TE loss. We also evaluated the length of time from TE placement to start date of adjuvant radiation as an outcome.
Results: 2,013 patients were included, of which 1,202 (59.7%) were treated with NACT and 811 (40.3%) had no chemotherapy. Rates of cellulitis/infection (10.0% versus 7.2%, p=0.028) and TE loss (9.2% versus 3.7%, p<0.001) were significantly higher in the NACT cohort compared to the control cohort. Hematoma was significantly higher in the control group than the intervention group (3.6% versus 2.0%, p=0.03). The NACT cohort had a median of 60 (Interquartile Range [IQR]: 52, 70) days from TE placement to adjuvant radiation while the control cohort had a median of 57 (48, 77) days (p=0.8). Multivariable logistic regression models demonstrated that patients with NACT were 2.31 times more likely to experience TE loss than those without NACT (OR=2.31, 95% CI: 1.40, 3.87, p=0.001). NACT was not a significant independent predictor of hematoma and cellulitis/infection.
Conclusion: Even after controlling for other variables, treatment with NACT significantly increases the rate of TE loss but no other complications analyzed. Despite the higher rate of TE loss, NACT does not significantly delay initiation of adjuvant radiation therapy. This information is important for patient education and can be used to assess the risks/benefits of immediate reconstruction in patients treated with NACT.
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