In a cohort study reported in JAMA Surgery, Hart et al found that treatment with either neoadjuvant or adjuvant chemotherapy was not associated with an increased risk of complications or poorer patient-reported outcomes in women undergoing mastectomy for breast cancer with immediate breast reconstruction.
Study Details
The study used data from the Mastectomy Reconstruction Outcomes Consortium Study. The cohort study prospectively assessed patient-reported outcomes and retrospectively analyzed complications in patients undergoing immediate implant-based or autologous reconstruction at 11 U.S. and Canadian centers from January 2012 to December 2017 who had ≥ 2 years of follow-up. Patients were excluded from the analysis if they had prophylactic mastectomy, delayed reconstruction, mixed-timing reconstruction, mixed reconstruction, a latissimus dorsi, superior gluteal artery perforator, or inferior gluteal artery perforator flap, or had received both neoadjuvant and adjuvant chemotherapy.
Complications included hematoma, wound infection, wound dehiscence, mastectomy skin flap necrosis, partial reconstructive flap necrosis, complete reconstructive flap loss, capsular contracture, implant malposition, seroma, and implant leakage, rupture, or deflation. Patient-reported outcomes (satisfaction with breast and physical, psychosocial, and sexual well-being) were assessed using the BREAST-Q questionnaire.
In this cohort study, neither neoadjuvant nor adjuvant chemotherapy was associated with the likelihood of complications in patients undergoing implant-based or autologous reconstruction, and chemotherapy was not associated with patient satisfaction with reconstruction or psychosocial well-being. This information can help patients and clinicians make informed decisions about breast reconstruction in the setting of chemotherapy.— Hart et al
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Key Findings
A total of 1,881 women (mean age = 49.9 years) were included in the analysis. Of these, 1,373 (73.0%) had implant-based procedures and 508 (27.0%) underwent autologous reconstruction. A total of 200 (10.6%) received neoadjuvant chemotherapy, 668 (35.5%) received adjuvant chemotherapy, and 1,013 (53.9%) received no chemotherapy.
Patients who did not receive chemotherapy were significantly older vs those who did (mean age = 51.6 years, P < .001). Patients who received neoadjuvant chemotherapy (54.0%) or adjuvant chemotherapy (48.1%) were significantly more likely to have received radiotherapy vs those who did not receive chemotherapy (14.6%; P < .001).
Among patients undergoing implant-based reconstruction, unadjusted 2-year rates of any complications were 31.2% among those receiving adjuvant chemotherapy and 28.8% among those receiving neoadjuvant chemotherapy, vs 24.1% among those not receiving chemotherapy (overall P = .02). However, on multivariable analysis, no significant differences were observed for adjuvant chemotherapy (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 0.92–1.73, P = .15) or neoadjuvant chemotherapy (OR = 1.10, 95% CI = 0.69–1.75, P = .68) vs no chemotherapy.
Among patients undergoing autologous reconstruction, unadjusted 2-year rates of any complications were 56.7% with adjuvant chemotherapy and 46.8% with neoadjuvant chemotherapy vs 49.8% for no chemotherapy (overall P = .27). On multivariate analysis, odds ratios were 1.22 (95% CI = 0.74–1.99, P = .44) for adjuvant chemotherapy and 0.65 (95% CI = 0.31–1.35, P = .25) for neoadjuvant chemotherapy vs no chemotherapy.
In analysis controlling for clinical covariates, virtually no significant differences in BREAST-Q patient-reported outcome subscale scores were observed between the adjuvant or neoadjuvant vs no chemotherapy groups. The single exception was a significantly lower score for sexual well-being with adjuvant chemotherapy vs no chemotherapy in the implant group (β = −4.97, 95% CI = −8.68 to −1.27, P = .009).
The investigators concluded, “In this cohort study, neither neoadjuvant nor adjuvant chemotherapy was associated with the likelihood of complications in patients undergoing implant-based or autologous reconstruction, and chemotherapy was not associated with patient satisfaction with reconstruction or psychosocial well-being. This information can help patients and clinicians make informed decisions about breast reconstruction in the setting of chemotherapy.”
Sarah E. Hart, MD, of the Department of Surgery, University of Michigan, Ann Arbor, is the corresponding author for the JAMA Surgery article.
Disclosure: The study was supported by a grant from the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
