Short- and long-term outcomes of immediate breast reconstruction surgery after neoadjuvant chemotherapy

Ishiba, Toshiyuki; Aruga, Tomoyuki; Miyamoto, Hiromi; Ishihara, Sakiko; Nara, Miyako; Adachi, Mio; Kumaki, Yuichi; Saita, Chiaki; Onishi, Mai; Goto, Risa; Iwamoto, Naoko; Yonekura, Rika; Honda, Yayoi; Fujii, Miwako; Tomita, Shoichi; Horiguchi, Shinichiro; Oda, Goshi; Nakagawa, Tsuyoshi; Fujioka, Tomoyuki; Terao, Yasunobu

doi:10.1007/s00595-021-02316-3

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…Of these articles, 214 were excluded after reviewing the titles and abstracts. Subsequently, after reading the full texts, an additional 55 articles that did not meet the inclusion criteria were excluded, leaving 14 articles for inclusion in the analysis 16–29 . The basic characteristics of the included studies are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

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The effect of neoadjuvant chemotherapy on surgical site wound infection after immediate breast reconstruction in patients with breast cancer: A meta‐analysis

Zhang,

Li,

Wang

et al. 2023

International Wound Journal

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Using a meta‐analysis approach, we conducted a comprehensive evaluation of the effect of neoadjuvant chemotherapy (NACT) on the incidence of surgical site wound infection during immediate breast reconstruction (IBR) following breast cancer. The aim was to provide evidence‐based support for the prevention of wound surgical site infection during IBR after breast cancer surgery. Relevant literature on the effects of NACT on IBR in patients with breast cancer published up until May 2023, was retrieved from various databases, including PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang databases, and China Biology Medicine Database. Two researchers performed the literature screening, data collection, and quality assessment of the included studies independently. The meta‐analysis was conducted using Stata version 17.0. Fourteen studies involving 3401 patients (599 in the intervention group and 2802 in the control group) were included in the analysis. The incidence of surgical site infection in the NACT group was higher than that in the control group, but the difference between the two groups was not statistically significant (7.17% vs. 4.85%, odds ratio: 1.02, 95% confidence interval: 0.70–1.50, p = 0.902). These findings suggest that NACT does not increase the risk of surgical site infection during IBR. However, owing to the variation in sample size and literature quality among the included studies, randomised controlled trials are needed to confirm the safety of IBR in patients receiving neoadjuvant chemotherapy.

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Section: Resultsmentioning

confidence: 99%

“…Subsequently, after reading the full texts, an additional 55 articles that did not meet the inclusion criteria were excluded, leaving 14 articles for inclusion in the analysis. 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 The basic characteristics of the included studies are shown in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

The effect of neoadjuvant chemotherapy on surgical site wound infection after immediate breast reconstruction in patients with breast cancer: A meta‐analysis

Zhang,

Li,

Wang

et al. 2023

International Wound Journal

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“… 22 During their study, the rates of major complications were 10.4% for the recipient site and 22.2% for the donor site, and complication rates were similar for patients who did and did not receive NAC before IR. Ishiba et al 23 analyzed outcomes among 909 patients who underwent either IBR or ATR; 43 of those patients underwent the procedure after NAC. They reported no significant differences in short-term outcomes between those patients and patients who underwent IR without previous NAC (7.0% vs 3.6%; P = 0.25).…”

Section: Discussionmentioning

confidence: 99%

Immediate Breast Reconstruction After Neoadjuvant Chemotherapy

Chi¹,

Zhang²,

Li³

et al. 2023

Ann Plast Surg

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Background Breast reconstruction has become an integral component of breast cancer treatment, especially for patients who are unable to undergo breast-conserving surgery after neoadjuvant chemotherapy (NAC). We analyzed factors influencing the type of immediate reconstruction surgery after NAC, as well as the complication rates for each surgery type. Methods The study included patients with breast cancer who underwent mastectomy following NAC from 2010 to 2021. Clinicopathological characteristics, unplanned reoperation rates, and the duration of postoperative hospitalization were analyzed in patients undergoing autologous tissue reconstruction (ATR, n = 127), implant-based reconstruction (IBR, n = 60), and combined autologous tissue and implant reconstruction (n = 60). Results A total of 1651 patients who received NAC before mastectomy were enrolled. Among them, 247 (15.0%) patients underwent immediate reconstruction (IR), whereas 1404 underwent mastectomy only. Patients in the IR group were younger (P < 0.001), had lower body mass index (P < 0.001), and exhibited earlier clinical (P = 0.003) and nodal (P < 0.001) stage than those in the non-IR group. Patients in the ATR group were older (P < 0.001) and had higher body mass index (P = 0.007), larger tumor size (P = 0.024), and more frequent childbearing history (P = 0.011) than those in the other groups. Complications resulting in unplanned reoperations were more frequent in the IBR group (P = 0.039). The duration of postoperative hospitalization was longest after ATR (P = 0.008). Conclusions Age and clinical tumor/nodal stage at presentation are associated with IR for patients undergoing mastectomy after NAC. For patients undergoing IR after NAC, ATR may be safer and more suitable than IBR.

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“…The safety of reconstruction after NAC has improved in recent years [10]. Varghese et al found that there was no significant difference in rates of complications or delay to adjuvant therapy among women with and without NAC [24].…”

Section: Discussionmentioning

confidence: 99%

“…NAC is used in patients with contraindications for surgery, locally advanced breast cancer and inflammatory breast cancer to downstage large tumors, improve local and distant site disease control and to increase breast conserving approaches [9,10].…”

Section: Methodological Approachmentioning

confidence: 99%

Prepectoral vs. Submuscular Immediate Breast Reconstruction in Patients Undergoing Mastectomy after Neoadjuvant Chemotherapy: Our Early Experience

Scardina

Leone

Biondi

et al. 2022

JPM

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Background: Conservative mastectomy with immediate prosthetic breast reconstruction (IPBR) is an oncologically accepted technique that offers improved esthetic results and patient quality of life. Traditionally, implants have been placed in a submuscular (SM) plane beneath the pectoralis major muscle (PMM). Recently, prepectoral (PP) placement of the prosthesis has been increasingly used in order to avoid morbidities related to manipulation of the PMM. The aim of this study was to compare outcomes of SM vs. PP IPBR after conservative mastectomy in patients with histologically proven breast cancer treated with neoadjuvant chemotherapy (NAC). Methods: In this retrospective observational study, we analyzed two cohorts of patients that underwent mastectomy with IPBR after NAC in our institution from January 2018 to December 2021. Conservative mastectomy was performed in 146 of the 400 patients that underwent NAC during the study period. Patients were divided into two groups based on the positioning of implants: 56 SM versus 90 PP. Results: The two cohorts were similar for age (mean age 42 and 44 years in the SM and PP group respectively) and follow-up (33 and 20 months, respectively). Mean operative time was 56 min shorter in the PP group (300 and 244 min in the SM and PP group). No significant differences were observed in overall major complication rates. Implant loss was observed in 1.78% of patients (1/56) in the SM group and 1.11% of patients (1/90) in PP group. No differences were observed between the two groups in local or regional recurrence. Conclusions: Our preliminary experience, which represents one of the largest series of patients undergoing PP-IPBR after NAC at a single institution documented in the literature, seems to confirm that PP-IPBR after NAC is a safe, reliable and effective alternative to traditional SM-IPBR with excellent esthetic and oncological outcomes; it is easy to perform, reduces operative time and minimizes complications related to manipulation of PPM. However, this promising results need to be confirmed in prospective trials with longer follow-up.

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Short- and long-term outcomes of immediate breast reconstruction surgery after neoadjuvant chemotherapy

Cited by 6 publications

References 12 publications

The effect of neoadjuvant chemotherapy on surgical site wound infection after immediate breast reconstruction in patients with breast cancer: A meta‐analysis

The effect of neoadjuvant chemotherapy on surgical site wound infection after immediate breast reconstruction in patients with breast cancer: A meta‐analysis

Immediate Breast Reconstruction After Neoadjuvant Chemotherapy

Prepectoral vs. Submuscular Immediate Breast Reconstruction in Patients Undergoing Mastectomy after Neoadjuvant Chemotherapy: Our Early Experience

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