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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2016

01-07-2016 | Reconstructive Oncology

Impact of Neoadjuvant and Adjuvant Chemotherapy on Immediate Tissue Expander Breast Reconstruction

Authors: Utku C. Dolen, MD, Alexandra C. Schmidt, MD, Grace T. Um, MD, Ketan Sharma, MD, Michael Naughton, MD, Imran Zoberi, MD, Julie M. Margenthaler, MD, FACS, Terence M. Myckatyn, MD, FACS, FRCSC

Published in: Annals of Surgical Oncology | Issue 7/2016

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Abstract

Background

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.

Methods

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.

Results

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).

Discussion

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.
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Metadata
Title
Impact of Neoadjuvant and Adjuvant Chemotherapy on Immediate Tissue Expander Breast Reconstruction
Authors
Utku C. Dolen, MD
Alexandra C. Schmidt, MD
Grace T. Um, MD
Ketan Sharma, MD
Michael Naughton, MD
Imran Zoberi, MD
Julie M. Margenthaler, MD, FACS
Terence M. Myckatyn, MD, FACS, FRCSC
Publication date
01-07-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 7/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5162-y

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