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Determinants of short and long term outcomes in patients undergoing immediate breast reconstruction following neoadjuvant chemotherapy
Author(s) -
Wengler Craig A.,
Valente Stephanie A.,
AlHilli Zahraa,
Woody Neil M.,
Muntean Julia H.,
Abraham Jame,
Tendulkar Rahul D.,
Djohan Risal,
O'Rourke Colin,
Crowe Joseph P.,
Grobmyer Stephen R.
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24741
Subject(s) - medicine , breast cancer , mastectomy , chemotherapy , surgery , stage (stratigraphy) , radiation therapy , adjuvant , neoadjuvant therapy , cancer , gastroenterology , paleontology , biology
Background We evaluated oncologic outcomes and complications of skin‐sparing mastectomy (SSM) and nipple‐sparing mastectomy (NSM) with immediate reconstruction (IR) after neoadjuvant chemotherapy (NAC) in patients with early‐stage and locally advanced breast cancer (BC). Methods BC patients from 2000 to 2014 treated with NAC followed by SSM/NSM and IR were reviewed. Patient demographics, tumor characteristics, NAC response, complications, and recurrence were analyzed. Results Two hundred sixty‐nine patients with 280 BCs were treated with NAC followed by SSM (94%) or NSM (6%) with IR. Median age was 47 (26‐72) years with a median follow‐up of 45 months. Pathologic complete response (pCR) was noted in 49 (17.5%) cases. Overall 30‐day complication rate was 13.2%. Variables associated with complications included BMI ( P < 0.0001), tobacco use ( P = 0.015), and adjuvant radiation ( P = 0.025). Local‐regional recurrence was 3.2% and metastatic recurrence was 13.2%. Variables predicting recurrence risk were pre‐NAC tumor size ( P < 0.001), residual tumor size ( P = 0.002), Grade III ( P = 0.002), HER‐2 negative ( P = 0.025), pre‐NAC nodal disease ( P = 0.05), and lack of pCR ( P = 0.045). Conclusion Following NAC, risk factors for complications in patients undergoing SSM/NSM with IR are high BMI, smoking, and adjuvant XRT. SSM/NSM following NAC is associated with excellent local control. These data support expanding the indications for NSM/SSM to include patients receiving NAC.