Impact of Neoadjuvant and Adjuvant Chemotherapy on Immediate Tissue Expander Breast Reconstruction
- 610 Downloads
Delayed wound healing or infection leads to premature tissue expander (TE) explantation after immediate postmastectomy breast reconstruction. A large study with sufficient duration of follow-up focusing on the impact of chemotherapy (CT) on premature TE removal after immediate breast reconstruction is lacking.
A retrospective review of patients undergoing immediate TE reconstruction was conducted. Multivariate analyses identified factors contributing to premature removal of TEs including neoadjuvant and adjuvant CT, specific chemotherapeutic regimens, and other factors like cancer stage, body mass index, smoking, radiation, and age. Kaplan–Meier curves were plotted to study the timing of premature TE removal.
Of 899 patients with TEs, 256 received no, 295 neoadjuvant, and 348 adjuvant CT. Premature removal occurred more frequently in the neoadjuvant (17.3 %) and adjuvant (19.9 %) cohorts than the no-CT (12.5 %) cohort (p = 0.056). Premature TE removal occurred earlier (p = 0.005) in patients who received no CT than those with adjuvant CT. Radiation in patients receiving neoadjuvant CT prolonged the mean time to premature removal (p = 0.003). In the absence of radiation, premature removal occurred significantly sooner with neoadjuvant than adjuvant CT (p = 0.035).
Premature removal of a TE occurs more commonly in patients treated with neoadjuvant or adjuvant CT and is most commonly observed 2–3 months after placement—well after the follow-up period recorded by the American College of Surgeons National Surgery Quality Improvement Program (NSQIP) database. These findings can be used to aid preoperative counseling and guide the timing of follow-up for these patients.
KeywordsTissue Expander Body Mass Index Group Acellular Dermal Matrix Premature Removal Mastectomy Flap
The authors are grateful to Dr. A. Tülay Bağci Bosi, MSc, PhD, epidemiologist at the Department of Public Health, University of Hacettepe School of Medicine, Turkey, for guidance and review of our statistical analyses.
No funds from any granting agency or company were used to prepare this manuscript. Dr. Myckatyn: Receives grant funding from Allergan which makes breast implants.
- 40.Kronowitz SJ, Lam C, Terefe W, et al. A multidisciplinary protocol for planned skin-preserving delayed breast reconstruction for patients with locally advanced breast cancer requiring postmastectomy radiation therapy: 3-year follow-up. Plast Reconstr Surg. 2011;127:2154–66.CrossRefPubMedGoogle Scholar
- 52.Fischer JP, Nelson JA, Serletti JM, Wu LC. Peri-operative risk factors associated with early tissue expander (TE) loss following immediate breast reconstruction (IBR): a review of 9305 patients from the 2005–2010 ACS-NSQIP datasets. J Plast Reconstr Aesthet Surg. 2013;66:1504–12.CrossRefPubMedGoogle Scholar
- 77.Cohen JB, Carroll C, Tenenbaum MM, Myckatyn TM. Breast implant-associated infections: the role of the National Surgical Quality Improvement Program and the local microbiome. Plast Reconstr Surg. 2015;136(5):921–9.Google Scholar