Influence of Neoadjuvant Chemotherapy on Outcomes of Immediate Breast Reconstruction

Azzawi, Khayam; Ismail, Amir; Earl, Helena; Forouhi, Parto; Malata, Charles M.

doi:10.1097/prs.0b013e3181da8699

Cited by 72 publications

(53 citation statements)

References 48 publications

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“…The American College of Surgeons National Surgical Quality Improvement Program's reported wound complication rate among breast cancer patients receiving neoadjuvant chemotherapy followed by surgery was low (3.1%), with a nonsignificant trend toward increased complications in those who underwent immediate reconstruction (OR 1.58 [95% CI 0.98 to 2.58]) (73). Similar data have been reported elsewhere (74)(75)(76)(77)(78)(79)(80)(81). It is important to acknowledge that reconstruction may impact the time to chemotherapy, but not necessarily in a clinically significant manner.…”

Section: What Is the Appropriate Timing Of Breast Reconstruction?supporting

confidence: 71%

Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

Budgell¹,

Quan²,

Mehling³

et al. 2014

CAN J PLAST SURG

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Section: What Is the Appropriate Timing Of Breast Reconstruction?supporting

confidence: 71%

Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

Budgell¹,

Quan²,

Mehling³

et al. 2014

CAN J PLAST SURG

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“…Schaverien and Munnoch 3 studied 87 patients receiving NC, finding that NC followed by immediate free autologous breast reconstruction had similar complication rates in 30 patients compared with patients not receiving NC. Azzawi et al 6 describe 171 patients undergoing 198 immediate breast reconstructions, including 64 free flaps, 74 pedicled flaps, and 60 implant-only procedures. Fifty-three patients (31.0%) received NC.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Chemotherapy and Short-term Morbidity in Patients Undergoing Mastectomy With and Without Breast Reconstruction

et al. 2014

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IMPORTANCE Neoadjuvant chemotherapy (NC) is increasingly being used in patients with breast cancer, and evidence-based reports related to its independent effects on morbidity after mastectomy with immediate breast reconstruction are limited. OBJECTIVE To determine the effect of NC on 30-day postoperative morbidity in women undergoing mastectomy with or without immediate breast reconstruction. DESIGN, SETTING, AND PARTICIPANTS All women undergoing mastectomy with or without immediate breast reconstruction from January 1, 2005, through December 31, 2011, at university and private hospitals internationally were analyzed using the American College of Surgeons National Surgical Quality Improvement Program 2005-2011 databases. Patients who received NC were compared with those without a history of NC to estimate the relative odds of 30-day postoperative overall, systemic, and surgical site morbidity using model-wise multivariable logistic regression. EXPOSURE Neoadjuvant chemotherapy. MAIN OUTCOMES AND MEASURES Thirty-day postoperative morbidity (overall, systemic, and surgical site). RESULTS Of 85 851 women, 66 593 (77.6%) underwent mastectomy without breast reconstruction, with 2876 (4.3%) receiving NC; 7893 patients were excluded because of missing exposure data. The immediate breast reconstruction population included 19 258 patients (22.4%), with 820 (4.3%) receiving NC. After univariable analysis, NC was associated with a 20% lower odds of overall morbidity in the group undergoing mastectomy without breast reconstruction (odds ratio [OR], 0.80; 95% CI, 0.71-0.91) but had no significant effect in the immediate breast reconstruction group (OR, 0.98; 95% CI, 0.79-1.23). After adjustment for confounding, NC was independently associated with lower overall morbidity in the group undergoing mastectomy without breast reconstruction (OR, 0.61; 95% CI, 0.51-0.73) and the immediate tissue expander reconstruction subgroup (OR, 0.49; 95% CI, 0.30-0.84). Neoadjuvant chemotherapy was associated with decreased odds of systemic morbidity in 4 different populations: complete sample (OR, 0.59; 95% CI, 0.49-0.71), mastectomy without breast reconstruction (OR, 0.59; 95% CI, 0.48-0.72), any immediate breast reconstruction (OR, 0.57; 95% CI, 0.37-0.88), and the tissue expander subgroup (OR, 0.41; 95% CI, 0.23-0.72). CONCLUSIONS AND RELEVANCE Our study supports the safety of NC in women undergoing mastectomy with or without immediate breast reconstruction. Neoadjuvant chemotherapy is associated with lower overall morbidity in the patients undergoing mastectomy without breast reconstruction and in those undergoing tissue expander breast reconstruction. In addition, the odds of systemic morbidity were decreased in patients undergoing mastectomy with and without immediate breast reconstruction. The mechanisms behind the protective association of NC remain unknown and warrant further investigation.

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“…60 Due to these conflicting data, some centers favor postponing breast reconstruction if postmastectomy radiation therapy is likely, 61 whereas others routinely perform immediate reconstruction despite the need for radiation. 62 The MD Anderson Cancer Center has championed the delayed-immediate reconstruction technique. 63 Patients who desire reconstruction undergo immediate tissue-expander placement followed by either reconstruction within 2 weeks if radiation is not required, or if radiation is required, deflation of the expander before radiation begins, reinflation after delivery of radiation, and subsequently delayed reconstruction.…”

Section: Adjuvant Therapiesmentioning

confidence: 99%

Patients opting for breast reconstruction following mastectomy: an analysis of uptake rates and benefit

Howard-McNatt¹

2013

BCTT

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For women with breast cancer who undergo a mastectomy, breast reconstruction offers improved psychological and cosmetic outcomes. We analyzed the rates of breast reconstruction and potential benefits to these women. The review was based on a PubMed search using the terms "reconstruction," "mastectomy," "rates," "benefits," and "breast cancer." Breast-reconstruction rates have continued to rise in recent years; however, there are definite barriers to widespread use of this procedure. These barriers include age, ethnicity, income, tumor characteristics, and the need for adjuvant radiation therapy. There are notable psychological advantages to women who receive breast reconstruction. These women also express an improved quality of life. Breast reconstruction is an acceptable technique for women undergoing mastectomy. It should be offered to all women in an immediate or delayed fashion, with guidance from their physician about the benefits and risks.

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Influence of Neoadjuvant Chemotherapy on Outcomes of Immediate Breast Reconstruction

Abstract: 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.

Cited by 72 publications

References 48 publications

Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

Neoadjuvant Chemotherapy and Short-term Morbidity in Patients Undergoing Mastectomy With and Without Breast Reconstruction

Patients opting for breast reconstruction following mastectomy: an analysis of uptake rates and benefit

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