Evaluation of mastectomy with immediate autologous latissimus dorsi breast reconstruction following neoadjuvant chemotherapy and radiation therapy: A single institution study of 111 cases of invasive breast carcinoma

Paillocher, N.; Florczak, Agnieszka; Richard, Marie-Claude; Classe, Jean Marc; Oger, Anne Sophie; Raro, Pédro; Wernert, Romuald; Lorimier, G.

doi:10.1016/j.ejso.2016.03.024

Cited by 36 publications

(31 citation statements)

References 23 publications

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“…The rates of short‐term complications in our patients were similar to those reported in this study. Other reports have similarly shown acceptable complication rates of immediate breast reconstruction after NAC, even when radiation therapy is also utilized . In terms of oncologic outcomes, Prabhu et al showed that IR may delay time to post‐mastectomy radiation in patients treated with neo‐adjuvant chemotherapy, but that there were no differences in locoregional control, disease‐specific survival, and overall survival when compared to a cohort of patients who did not have breast reconstruction .…”

Section: Discussionmentioning

confidence: 99%

Does response to neo-adjuvant chemotherapy impact breast reconstruction?

et al. 2018

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Neo-adjuvant chemotherapy (NAC) is administered in breast cancer treatment for downstaging of disease. Here, we determined the impact of response to NAC on breast reconstruction uptake. A prospective NAC and mastectomy database with or without reconstruction were reviewed with IRB approval. Univariable analyses were conducted using Kruskal-Wallis or Fisher's exact tests. Multivariable logistic regression was used to adjust for potential confounders. We identified 271 patients with unilateral breast cancer receiving NAC and either unilateral or bilateral mastectomy from 9/2013 to 5/2016. Seventy patients (25.8%) had a pCR to NAC. One hundred and seventy-five patients (64.6%) had immediate reconstruction (IR), and 96 had no IR. On univariable analysis, younger age (P < .001), lower T-stage at presentation (P < .001), bilateral versus unilateral mastectomy (P<.001) and HR-negative tumor subtype (P = .006) were significantly associated with higher IR rates. On multivariable analysis, pCR (P = .792) and tumor subtype (P = 0.061) were not significantly associated with IR; T-stage was significantly associated with IR (P < .001), such that patients with T4 tumors at presentation had lower odds of IR (OR 0.10, 95% CI 0.02-0.50), even when accounting for response to NAC. One hundred and seventy-three patients (63.8%) received adjuvant radiation therapy; this was associated with lower IR frequency (P = .048) but was not associated with reconstruction type (tissue expander versus autologous, P = 1.0) among 175 patients who had IR. In patients who have mastectomy after NAC, IR is influenced by age, T-stage at presentation, and choice of bilateral mastectomy, but not by response to NAC. A subset of patients who are young, with earlier T-stage and pCR, is more likely to proceed with bilateral mastectomy.

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Section: Discussionmentioning

confidence: 99%

Does response to neo-adjuvant chemotherapy impact breast reconstruction?

et al. 2018

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“…This sequence has been shown to have comparable morbidity and oncological recurrence rates. [8][9][10]21 A similar protocol was proposed more recently by Grinsell's group in 2013. 22 However, none of these studies in the literature have exclusively used, or examined, the rate of microsurgical complications in free autologous breast reconstruction in the setting of neoadjuvant radiotherapy.…”

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confidence: 99%

“…The benefits of immediate breast reconstruction (IBR) are well described and include superior aesthetic results, increased quality of life, and improved psychological outcomes. [8][9][10][11] However, multiple studies have shown the increased morbidity of immediate reconstruction in the setting of PMRT. In regard to autologous reconstruction, they report significantly increased rates of flap fibrosis, fat necrosis, and flap shrinkage, which in severe cases can necessitate a second flap to salvage the reconstruction.…”

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confidence: 99%

Neoadjuvant Radiotherapy: Changing the Treatment Sequence to Allow Immediate Free Autologous Breast Reconstruction

Hughes

Neoh

2018

J reconstr Microsurg

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“…For patients with previous radiotherapy for local recurrence or after NAC and radiotherapy [19][20][21], the latissimus dorsi-muscle nourishes and protects the thin skin. In these cases, RLDFR can be associated with implant according to breast size and according to patient's choice.…”

Section: Discussionmentioning

confidence: 99%

Skin sparing mastectomy and robotic latissimus dorsi-flap reconstruction through a single incision

et al. 2019

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Background: Robotic latissimus dorsi-flap reconstruction (RLDFR) after skin-sparing mastectomy (SSM) for breast cancer (BC) has been performed through a single nipple incision. We report results of SSM with RLDFR, mainly with analysis of feasibility, morbidity, indications, and technique standardization. Methods: We determined characteristics of patients, previous treatment of BC, and type of reconstruction. Surgical technique, duration of surgery, and complication rate were reported according to three successive periods: P1-3. Results: Forty RLDFR, with breast implant for 16 patients, with previous breast radiotherapy in 30% had been performed. In logistic regression, factors significantly associated with duration of surgery ≥ 300 min were P2 (OR 0.024, p = 0.004) and P3 (OR 0.012, p = 0.004) versus P1. The median mastectomy weight was 330 g and 460 g for BMI < and ≥ 23.5 (p = 0.025). Length of hospitalization was 4 days. Total complication rate was 20% (8/40): seven breast complications (four re-operations) and one RLDF complication with re-operation. Periods were significantly predictive of complications (p = 0.045). Conclusion: SSM with RLDFR is feasible, safe, and reproducible. We reported a decrease of duration of surgery, length of post-operative hospitalization, and complication rate.

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Evaluation of mastectomy with immediate autologous latissimus dorsi breast reconstruction following neoadjuvant chemotherapy and radiation therapy: A single institution study of 111 cases of invasive breast carcinoma

Cited by 36 publications

References 23 publications

Does response to neo-adjuvant chemotherapy impact breast reconstruction?

Does response to neo-adjuvant chemotherapy impact breast reconstruction?

Neoadjuvant Radiotherapy: Changing the Treatment Sequence to Allow Immediate Free Autologous Breast Reconstruction

Skin sparing mastectomy and robotic latissimus dorsi-flap reconstruction through a single incision

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