Neoadjuvant Chemotherapy Is Not Associated with Increased Risk of Complications in Immediate Breast Reconstruction

Purpose:

Advances in the treatment of breast cancer have resulted in the increased use of neoadjuvant chemotherapy (NAC). Women who undergo NAC tend to be younger and have higher rates of mastectomy. These women are also having immediate breast reconstruction (IBR) but there is a paucity of literature evaluating the safety of this practice. The purpose of this study is to evaluate the impact of NAC on complication rates in women undergoing IBR.

 

Methods:

The National Surgical Quality Improvement Program (NSQIP) database was queried to retrospectively evaluate the nature and incidence of postoperative complications of IBR following mastectomy. The study population consisted of two cohorts; one where women had IBR with abdominal flaps and the other consisted of women who had IBR with expanders or implants. To establish the cohort of IBR, patients who didn’t have a mastectomy listed as either a primary or secondary procedure, were excluded. In all, the records of 13833 procedures across NSQIP-participating sites were reviewed for demographics, patient clinical characteristics, preoperative lab values, intraoperative practices, and postoperative complications including incidences of surgical site infection (SSI), reoperation or readmission, need for transfusion, and incidence of a cardiopulmonary or thromboembolic event. Univariate and multivariate regression analyses were used to compare complication rates between NAC and non-NAC populations, and to determine if complication rates were impacted by the receipt of NAC. Independent variables for the regression analysis included patient demographics, medical history, and intraoperative factors.

 

Results:

12000 patients were identified as having implant based IBR; 648 of them received NAC. Patients receiving NAC were younger (p<0.001), had lower pre-operative white blood cell (WBC) counts (p<0.001), and hematocrits (p<0.001), and 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 (p<0.001). Multivariate analyses revealed that in patients undergoing IBR with expanders or implants, NAC was not associated with higher complication rates, hospital readmission, or reoperation rates.

Of the 1,833 patients who had abdominal flap reconstruction, (Group 2), 89 patients received NAC. The NAC cohort was younger and had lower pre-operative WBC counts (p<0.001), platelet levels (p<0.05) and hematocrit (p<0.001). Multivariate analyses revealed that in patients undergoing IBR with abdominal flaps, NAC was not associated with higher complication rates, hospital readmission, or reoperation rates.

 

Conclusions:

The use of neoadjuvant chemotherapy prior to mastectomy is safe for immediate reconstruction, regardless of the type of reconstruction used. 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.