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Immediate Breast Reconstruction vs Conventional Mastectomy After Neoadjuvant Chemotherapy: Long-Term Outcomes


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In a Korean single-institution study reported in JAMA Surgery, Wu et al found no differences in long-term breast cancer outcomes between women who underwent immediate breast reconstruction with nipple-sparing or skin-sparing mastectomy vs those who underwent conventional mastectomy alone after neoadjuvant chemotherapy.

Study Details

The study was a propensity score–matched, case-control study among a total population of 1,266 women at Asan Medical Center, Seoul, who underwent neoadjuvant chemotherapy followed by mastectomy with or without breast reconstruction between January 2010 and November 2016. After propensity score matching, the study population consisted of 323 patients who underwent immediate breast reconstruction with nipple-sparing mastectomy or skin-sparing mastectomy and 323 who underwent conventional mastectomy alone. The median age of patients was 42 years in those undergoing immediate breast reconstruction and 46 years in those undergoing conventional mastectomy.

"The long-term oncologic outcomes of immediate breast reconstruction with nipple-sparing mastectomy/skin-sparing mastectomy for breast cancer in this study appeared to be comparable to those of conventional mastectomy alone after neoadjuvant chemotherapy."
— Wu et al

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Key Findings

Median follow-up was 67 months (range = 17–125 months) in the immediate breast reconstruction group and 68 months (range = 17–126 months) in the conventional mastectomy group. No significant differences were observed between the immediate breast reconstruction vs conventional mastectomy groups in the rates of local recurrence (3.7% vs 3.4%, P = .83), regional recurrence (7.1% vs 5.3%, P = .33), or distant metastasis (17.3% vs 18.6%, P = .68).

Among 187 patients in the immediate breast reconstruction group who underwent nipple-sparing mastectomy, 2.1% experienced recurrence at the nipple-areola complex; the rates were 4.8% for local recurrence, 7.0% for regional recurrence, and 16% for distant metastasis. Of the 136 patients who underwent skin-sparing mastectomy, the rates were 2.2% for local recurrence, 7.4% for regional recurrence, and 19.1% for distant metastasis.

No significant differences between immediate breast reconstruction and conventional mastectomy were observed for 5-year local recurrence–free survival (95.6% vs 96.7%, hazard ratio [HR] = 1.124, P = .78), disease-free survival (76.5% vs 79.9%, HR = 1.089, P = .60), distant metastasis–free survival (82.5% vs 82.5%, HR = 0.941, P = .74), or overall survival (92.0% vs 89.3%, HR = 0.847, P = .49).

Among 126 patients in the immediate breast reconstruction group vs 135 patients in the conventional mastectomy group without a response to neoadjuvant chemotherapy, there were no significant differences in the rates of 5-year local recurrence–free survival (96.4% vs 95.1%, HR = 0.641, P = .48), disease-free survival (74.5% vs 74.8%, HR = 0.949, P = .83), distant metastasis–free survival (79.5% vs 78.7%, HR = 0.924, P = .77), or overall survival (91.4% vs 90.6%, HR = 1.032, P = .93).

The investigators concluded: “The long-term oncologic outcomes of immediate breast reconstruction with nipple-sparing mastectomy/skin-sparing mastectomy for breast cancer in this study appeared to be comparable to those of conventional mastectomy alone after neoadjuvant chemotherapy, suggesting the feasibility of immediate breast reconstruction with nipple-sparing mastectomy/skin-sparing mastectomy in the neoadjuvant chemotherapy setting.”

Beom Seok Ko, MD, PhD, of the Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, is the corresponding author of the JAMA Surgery article.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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