Plastic Surgery Research Council

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Chemotherapy Effects on Clinical Complications and Patient Reported Outcomes after Immediate Breast Reconstruction
Sarah E. Hart, MD1, David L. Brown, MD1, Andrea L. Pusic, MD, MHS2, Hyungjin M. Kim, ScD1, Ji Qi, MS1, Jennifer B. Hamill, MPH1, Edwin G. Wilkins, MD, MS1.
1University of Michigan, Ann Arbor, MI, USA, 2Brigham and Women's Hospital, Boston, MA, USA.

PURPOSE: Many women undergoing immediate breast reconstruction also require pre or post-operative chemotherapy for cancer treatment. The effects of chemotherapy on breast reconstruction outcomes have not been well described. We evaluated the impact of neoadjuvant and adjuvant chemotherapies on complications and patient-reported outcomes (PROs) in immediate reconstruction.
METHODS: The MROC Study prospectively assessed complications and PROs in patients undergoing immediate implant-based or autologous reconstruction at 11 centers from 2012 to 2015. Complications (total and major), and PROs (satisfaction, and physical, psychosocial and sexual well-being) were evaluated two years postoperatively, using medical records and the BREAST-Q, respectively. Mixed models compared outcomes across cohorts receiving neoadjuvant, adjuvant or no chemotherapy, controlling for clinical covariates and sites.
RESULTS: Among 1881 patients, 10.6% received neoadjuvant, 35.5% adjuvant, and 53.9% no chemotherapy. Procedures included implant-based (73%) and autologous reconstructions (27%). Significant cohort differences were noted for age, laterality, lymph node management, mastectomy type, and timing of radiation. Although chemotherapy had no significant effects on complication rates for autologous reconstructions, a higher risk of major complications was seen in implant patients with adjuvant chemotherapy compared to no chemotherapy (OR 1.42, p=0.05). With the exception of sexual well-being, for which adjuvant chemotherapy was associated with significantly lower scores in implant patients (p <0.01), there were no significant chemotherapy effects on PROs.
CONCLUSION: While the effects of chemotherapy on complications in immediate breast reconstruction appeared to vary by chemotherapy timing and procedure type, chemotherapy had little impact on PROs. These findings may prove useful in treatment planning and counseling for breast cancer patients.


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