New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study

Abstract

Feasibility and oncological safety of postadjuvant skin-sparing mastectomy (SSM) plus immediate breast reconstruction (IBR) cannot be evaluated by randomized trials. However, comparative study could modify guidelines for the oncosurgical treatment of invasive breast cancer. Our study compared the feasibility, oncological safety and esthetic outcome of SSM plus latissimus dorsi (LD) flap IBR after chemotherapy (CT) and radiotherapy (RT) with the standard management for invasive breast cancer: mastectomy as primary treatment, adjuvant CT and RT, and LD flap delayed breast reconstruction (DBR). Twenty-six selected patients with stages IIA-IIIA breast cancer were offered post-neoadjuvant SSM plus IBR with LD flap plus implant (IBR group). Seventy-eight other patients had primary mastectomy, adjuvant CT and RT, and LD-assisted DBR (DBR group). After 4.1 years (range 1-8) of follow-up, feasibility, oncological safety, and esthetic outcome were compared. Sixteen (61%) early complications were reported for the IBR group versus 44 (56%) for the DBR group (P = 0.645). Early implant loss was 0% in IBR versus 12% in DBR. IBR had 8 (30%) late complications versus 17 (21%) for DBR (P = 0.362). Capsular contracture and reconstruction failure rates were similar. Local recurrence was 7.7% (2/26) in IBR and 6.4% (5/78) in DBR (P = 0.823). Cosmetic evaluation by independent physicians and by the patients themselves was identical in the two groups. Our concept provides a basis for offering more women the opportunity to elect for immediate reconstruction, even in the setting of radiation therapy.

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

“…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.…”

Mastectomy with immediate breast reconstruction after neoadjuvant chemotherapy and radiation therapy. A new option for patients with operable invasive breast cancer. Results of a 20 years single institution study

“…Recently, a team prospectively applied our concept in a small series of patients confirming our results. 30 However, our findings need to be confirmed by larger prospective studies, including aesthetic and quality of life evaluation, before proposing this approach in routine clinical practice. M A N U S C R I P T…”

Patient Selection and Technical Considerations in Nipple-Sparing and Areola-Sparing Mastectomy

“…Lower satisfaction rates were seen in patients with larger breast volumes (P=0.01), increased BMI (P=0.034), and larger tissue expander volumes (P=0.007). Good to excellent reconstructive outcomes in patients undergoing SSM/NSM are confirmed by other authors [15,[60][61][62]. Psycho-oncologic benefits when preserving the NAC should not be underestimated [63••].…”