The Effect of Neoadjuvant Chemotherapy on Complication Rates in Implant Based Reconstruction.
Andrew Karam, MD candidate, Ilya Rakitin, M.D., Efstathios Karamanos, M.D., Ilan Rubinfeld, MD, Dunya Atisha, MD, FACS.
Henry Ford Hospital, Detroit, MI, USA.
Advances in the treatment of breast cancer have resulted in the increased use of neoadjuvant chemotherapy. Women who have neoadjuvant chemotherapy(NAC) tend to be younger and have mastectomies at higher rates. This population of women are having immediate breast reconstruction (IBR) but there is a paucity of literature evaluating the safety of this practice, particularly with the use of implants. The purpose of this study is to evaluate the impact of neoadjuvant chemotherapy on complication rates in women undergoing mastectomy with implant based IBR.
The National Surgical Quality Improvement Program (NSQIP) database was queried to retrospectively evaluate the nature and incidence of postoperative complications of implant based IBR following mastectomy. The records of 12000 procedures across 680 NSQIP-participating sites were reviewed for demographics, clinical characteristics, intraoperative practices, and postoperative outcomes of interest including incidences of surgical site infection (SSI), reoperation, and hospital readmission. Univariate and multivariate regressions were used to compare complication rates between NAC and non-NAC populations and to determine perioperative factors predictive of the formerly mentioned complications.
Of the 12000 patients receiving implant based IBR, 648 received NAC. In addition to being younger, patients receiving NAC were less likely to have a history of radiation therapy (XRT) (p<0.001), diabetes (p<0.05), but more likely to receive bilateral mastectomy (P<0.001) and twice as likely to require a dermal matrix in their reconstruction (p<0.001). Univariate analysis, concluded that there was no significant difference in the incidence of any postoperative complications including cardiopulmonary complications, SSI, return to OR, or hospital readmission. While taking into account age, BMI, ASA class, operation length, dermal matrix use, procedure laterality (bilateral vs. unilateral mastectomy), and histories of smoking, diabetes and XRT, our multivariate regression analysis noted no significant association between NAC use and any serious complication [AOR (95% CI):0.93 (0.56, 1.45)], any SSI [1.02 (0.61, 1.62)], any hospital readmission [ 0.73 (0.36, 1.37)], or any return to OR [0.71 (0.48, 1.00)]. Nevertheless, the factors of BMI, ASA class, operation length, and XRT were consistently associated (p<0.05) with increase in complications.
The use of neoadjuvant chemotherapy prior to mastectomy is safe for immediate reconstruction, whether with tissue expanders or direct to implant. In considering the survival and down-staging benefits of neoadjuvant chemotherapy, and the psychological and functional benefits of breast reconstruction, patients should be offered the option of immediate breast reconstruction following NAC related mastectomy.
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