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The impact of neoadjuvant chemotherapy on the surgical outcomes of immediate breast reconstruction remains controversial. The aim of this study was to analyze the incidence of complications of immediate deep inferior epigastric artery perforator (DIEP) flap breast reconstructions in patients who received neoadjuvant chemotherapy compared to patients without neoadjuvant chemotherapy prior to surgery.
A multicenter, retrospective cohort study was conducted of all patients who underwent immediate DIEP flap breast reconstruction between January 2010 and June 2017. Patients were divided in two groups as breast reconstructions with or without neoadjuvant chemotherapy, respectively. The primary outcome was the incidence of postoperative flap re-explorations, recipient-site complications and donor-site complications.
In total 432 immediate DIEP flap breast reconstructions in 326 patients were included. Forty-eight patients (n = 67 flaps) received neoadjuvant chemotherapy prior to immediate breast reconstruction and 278 patients (n = 365 flaps) did not. No statistically significant differences for any major (4.5% vs. 10.4%; p = 0.175) or minor (16.4% vs. 24.7%; p = 0.191) recipient-site complication were observed. Donor-site complications were recorded in 9 (18.8%) and 62 (22.2%) patients, respectively (p = 0.587). There was no difference in need for flap re-exploration between groups (3.0% vs. 8.5%; p = 0.139). Correction for potential confounding variables did not result in significant differences.
This study demonstrated similar complication rates for patients with and without neoadjuvant chemotherapy prior to immediate breast reconstruction, indicating that it is safe to perform an immediate DIEP flap breast reconstruction after neoadjuvant chemotherapy.
Supplementary material 1 (DOCX 21 kb)10549_2019_5241_MOESM1_ESM.docx
Smith IE, Lipton L (2001) Preoperative/neoadjuvant medical therapy for early breast cancer. Lancet Oncol 2(9):561–570. https://doi.org/10.1016/S1470-2045(01)00490-9 CrossRef
Mieog JS, van der Hage JA, van de Velde CJ (2007) Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd005002.pub2
Early Breast Cancer Trialists’ Collaborative G (2018) Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol 19(1):27–39. https://doi.org/10.1016/S1470-2045(17)30777-5 CrossRef
Van de Wiel M, Dockx Y, Van den Wyngaert T, Stroobants S, Tjalma WA, Huizing MT (2016) Neoadjuvant systemic therapy in breast cancer: challenges and uncertainties. Eur J Obstet Gynecol Reprod Biol 210:144–156. https://doi.org/10.1016/j.ejogrb.2016.12.014 CrossRef
Cemal Y, Albornoz CR, Disa JJ, McCarthy CM, Mehrara BJ, Pusic AL, Cordeiro PG, Matros E (2013) A paradigm shift in US breast reconstruction: Part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg 131(3):320e–326e. https://doi.org/10.1097/prs.0b013e31827cf576 CrossRef
Jagsi R, Jiang J, Momoh AO, Alderman A, Giordano SH, Buchholz TA, Kronowitz SJ, Smith BD (2014) Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol 32(9):919–926. https://doi.org/10.1200/JCO.2013.52.2284 CrossRef
Hu ES, Pusic AL, Waljee JF, Kuhn L, Hawley ST, Wilkins E, Alderman AK (2009) Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship Period. Plast Reconstr Surg 124(1):1–8. https://doi.org/10.1097/PRS.0b013e3181ab10b2 CrossRef
Yueh JH, Slavin SA, Adesiyun T, Nyame TT, Gautam S, Morris DJ, Tobias AM, Lee BT (2010) Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg 125(6):1585–1595. https://doi.org/10.1097/PRS.0b013e3181cb6351 CrossRef
Craft RO, Colakoglu S, Curtis MS, Yueh JH, Lee BS, Tobias AM, Lee BT (2011) Patient satisfaction in unilateral and bilateral breast reconstruction [outcomes article]. Plast Reconstr Surg 127(4):1417–1424. https://doi.org/10.1097/PRS.0b013e318208d12a CrossRef
Healy C, Allen RJ Sr (2014) The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg 30(2):121–125. https://doi.org/10.1055/s-0033-1357272
Zhong T, Hu J, Bagher S, Vo A, O’Neill AC, Butler K, Novak CB, Hofer SO, Metcalfe KA (2016) A comparison of psychological response, body image, sexuality, and quality of life between immediate and delayed autologous tissue breast reconstruction: a prospective long-term outcome study. Plast Reconstr Surg 138(4):772–780. https://doi.org/10.1097/PRS.0000000000002536 CrossRef
Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW (2000) The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 26(1):17–19 CrossRef
Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL (2006) Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg 118(5):1100–1109. https://doi.org/10.1097/01.prs.0000236898.87398.d6 (discussion 1110–1101) CrossRef
Albino FP, Koltz PF, Ling MN, Langstein HN (2010) Irradiated autologous breast reconstructions: effects of patient factors and treatment variables. Plast Reconstr Surg 126(1):12–16. https://doi.org/10.1097/PRS.0b013e3181da878f
Schaverien MV, Munnoch DA (2013) Effect of neoadjuvant chemotherapy on outcomes of immediate free autologous breast reconstruction. Eur J Surg Oncol 39(5):430–436. https://doi.org/10.1016/j.ejso.2013.02.015 CrossRef
Donker M, Hage JJ, Woerdeman LA, Rutgers EJ, Sonke GS, Vrancken Peeters MJ (2012) Surgical complications of skin sparing mastectomy and immediate prosthetic reconstruction after neoadjuvant chemotherapy for invasive breast cancer. Eur J Surg Oncol 38(1):25–30. https://doi.org/10.1016/j.ejso.2011.09.005 CrossRef
Zweifel-Schlatter M, Darhouse N, Roblin P, Ross D, Zweifel M, Farhadi J (2010) Immediate microvascular breast reconstruction after neoadjuvant chemotherapy: complication rates and effect on start of adjuvant treatment. Ann Surg Oncol 17(11):2945–2950. https://doi.org/10.1245/s10434-010-1195-9 CrossRef
Azzawi K, Ismail A, Earl H, Forouhi P, Malata CM (2010) Influence of neoadjuvant chemotherapy on outcomes of immediate breast reconstruction. Plast Reconstr Surg 126(1):1–11. https://doi.org/10.1097/PRS.0b013e3181da8699 CrossRef
Warren Peled A, Itakura K, Foster RD, Hamolsky D, Tanaka J, Ewing C, Alvarado M, Esserman LJ, Hwang ES (2010) Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction. Arch Surg 145(9):880–885. https://doi.org/10.1001/archsurg.2010.163 CrossRef
Song J, Zhang X, Liu Q, Peng J, Liang X, Shen Y, Liu H, Li H (2014) Impact of neoadjuvant chemotherapy on immediate breast reconstruction: a meta-analysis. PLoS ONE 9(5):e98225. https://doi.org/10.1371/journal.pone.0098225 CrossRef
Narui K, Ishikawa T, Satake T, Adachi S, Yamada A, Shimada K, Shimizu D, Kida K, Sugae S, Ichikawa Y, Tanabe M, Sasaki T, Endo I (2015) Outcomes of immediate perforator flap reconstruction after skin-sparing mastectomy following neoadjuvant chemotherapy. Eur J Surg Oncol 41(1):94–99. https://doi.org/10.1016/j.ejso.2014.09.001 CrossRef
Beugels J, Hoekstra LT, Tuinder SM, Heuts EM, van der Hulst RR, Piatkowski AA (2016) Complications in unilateral versus bilateral deep inferior epigastric artery perforator flap breast reconstructions: a multicentre study. J Plast Reconstr Aesthet Surg 69(9):1291–1298. https://doi.org/10.1016/j.bjps.2016.04.010 CrossRef
Beugels J, Bod L, van Kuijk SMJ, Qiu SS, Tuinder SMH, Heuts EM, Piatkowski A, van der Hulst R (2018) Complications following immediate compared to delayed deep inferior epigastric artery perforator flap breast reconstructions. Breast Cancer Res Treat 169(2):349–357. https://doi.org/10.1007/s10549-018-4695-0 CrossRef
Abt NB, Flores JM, Baltodano PA, Sarhane KA, Abreu FM, Cooney CM, Manahan MA, Stearns V, Makary MA, Rosson GD (2014) Neoadjuvant chemotherapy and short-term morbidity in patients undergoing mastectomy with and without breast reconstruction. JAMA Surg 149(10):1068–1076. https://doi.org/10.1001/jamasurg.2014.1076 CrossRef
- The influence of neoadjuvant chemotherapy on complications of immediate DIEP flap breast reconstructions
J. L. W. Meijvogel
S. M. H. Tuinder
V. C. G. Tjan-Heijnen
E. M. Heuts
R. R. W. J. van der Hulst
- Springer US
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