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Optimal breast reconstruction type for patients treated with neoadjuvant chemotherapy, mastectomy followed by radiation therapy

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Abstract

Purpose

To explore the optimal type of breast reconstruction and the time interval to postmastectomy radiotherapy (PMRT) associated with lower complications in breast cancer patients receiving neoadjuvant chemotherapy.

Methods

We reviewed the medical records of 300 patients who received neoadjuvant chemotherapy, mastectomy with breast reconstruction and PMRT at our institution from 2000 to 2017. Reconstruction types included autologous flaps (AR), single-stage-direct-to-implant and two-stages expander/implant (TE/I). The primary endpoint was the rate of reconstruction complications including infection, skin and fat necrosis. Subgroup analysis compared rates of capsular contracture, implant rupture, implant exposure and overall implant failure in single-stage-direct-to-implant to TE/I. The secondary endpoint was identifying the time interval between surgery with immediate implant-based reconstruction and PMRT associated with lower probability of implant failure. Logistic regression models, Kaplan–Meier estimates and Polynomial regression were used to assess endpoints.

Results

The median follow-up was 43.5 months. 29.3%, 28.3% and 42.4% of the cohort had AR, TE/I and single-stage-direct-to-implant D, respectively. The 5-year cumulative incidence rate of complications was 14.0%, 29.7% and 19.4% for AR, TE/I and single-stage-direct-to-implant, respectively (Log rank p = 0.02). Multivariate analysis showed significant association between TE/I and higher risk of infection (OR 8.1, p = 0.009) compared to AR, while single-stage-direct-to-implant and AR were comparable (OR 3.2, p = 0.2). On subgroup analysis, TE/I was significantly associated with higher rates of implant failure. The mean wait time to deliver PMRT after immediate reconstruction with no adjuvant chemotherapy was 8.4 and 10.7 weeks in single-stage-direct-to-implant and TE/I, respectively (p < 0.005). Delivering PMRT after 8 weeks of surgery yielded 10% probability of reconstruction failure in single-stage-direct-to-implant versus 40% in TE/I.

Conclusion

In comparison to two stages reconstruction, single-stage-direct-to-implant following neoadjuvant chemotherapy has lower complications and offers timely delivery of PMRT.

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Funding

N/A, no funding available for this study.

Author information

Author notes

  1. Laura Salama

    Present address: Charles E. Schmidt College of Medicine, Boca Raton, FL, USA

Authors and Affiliations

  1. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA

    George E. Naoum, Oluwadamilola T. Oladeru, Andrzej Niemierko, Laura Salama, Alice Ho & Alphonse G. Taghian

  2. Department of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA

    Jonathan Winograd & Amy Colwell

  3. Department of Clinical Oncology, Alexandria University, Alexandria, Egypt

    Waleed O. Arafat

  4. Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA

    Barbara Smith

Authors
  1. George E. Naoum
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  2. Oluwadamilola T. Oladeru
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  4. Laura Salama
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Contributions

Andrzej Niemierko was responsible for statistical analysis.

Corresponding author

Correspondence to Alphonse G. Taghian.

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Conflict of interest

Alphonse Taghian is on the Scientific Advisory Board of Puretech Health and Consultant in VisionRT. None of it is relevant to the current study. The rest of the authors have nothing to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional IRB approval Protocol #: 2017P001175.

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Naoum, G.E., Oladeru, O.T., Niemierko, A. et al. Optimal breast reconstruction type for patients treated with neoadjuvant chemotherapy, mastectomy followed by radiation therapy. Breast Cancer Res Treat 183, 127–136 (2020). https://doi.org/10.1007/s10549-020-05747-7

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  • DOI: https://doi.org/10.1007/s10549-020-05747-7

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