Neoadjuvante chemotherapy and immediate breast reconstruction: a good option?

CAMMAROTA, MARCELA CAETANO; ESTEVES, BRUNO PEIXOTO; DAHER, JOSÉ CARLOS; LAMARTINE, JEFFERSON DI; CURADO, DHYEGO MOLINARI DI CASTRO; CÂMARA FILHO, JOÃO PEDRO PONTES; BORGATTO, MARINA DE SOUZA; BENEDIK, ALBERTO

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Revista Brasileira de Cirurgia Plástica

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Original Article • Rev. Bras. Cir. Plást. 28 (4) • Oct-Dec 2013 • https://doi.org/10.5935/2177-1235.2013RBCP0612 copy

Neoadjuvante chemotherapy and immediate breast reconstruction: a good option?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

The combination of neoadjuvant chemotherapy and imme-diate breast reconstruction is a field under discussion. There are doubts whether the association of events could result in an increase of postopera-tive complications in patients undergoing the surgical procedure.

Methods:

Retrospective study of patients who underwent immediate breast re-construction from January 2010 to January 2012. Patients submitted to ne-oadjuvant chemotherapy were compared with those who had not re-ceived any form of chemotherapy and those who received adjuvant chemotherapy.

Results:

Fifty-four patients were selected, totalizing 71 im-mediate breast reconstructions. Thirteen patients received neoadjuvant chemotherapy (15 reconstructions) twenty-three patients did not receive chemotherapy (33 reconstructions) and eighteen received adjuvant chemotherapy (23 reconstructions). Minor complications occurred in 33.3% of breast reconstruction in the group undergoing neoadjuvant ther-apy. There were 6.7% of major complications in the same group. There was no statistical differences in the number of minor and major complica-tions between groups.

Conclusion:

In the series analyzed, the use of neo-adjuvant chemotherapy did not increase the number of postoperative complications in patients undergoing immediate breast reconstruction.

Keywords:
Breast cancer; Mastectomy; Mammaplasty; Chemotherapy; Postoperative complications; Reconstructive

	Group 1: patients who received neoadjuvant chemotherapy		Group 2: Patients who did not receive chemotherapy		Group 3: Patients who received adjuvant chemotherapy		Total		Statistical significance
Total no. of patients	13	100%	23	100%	18	100%	54	100%
Mean age (minimum -maximum), years	44,2	(28 - 67)	54,3	(32 - 73)	52,2	(32 - 69)	51,2	(28 - 73)	0,053¹ 1 Analysis of variance: value close to significance. Homogeneous variances by the Levene test (P = 0.679).
Comorbidities	6	46%	10	43%	8	44%	24	44,4%	0,972² 2 Chi-square test for the presence or absence of comorbidities.
History of smoking	3	23,1%	6	26,1%	4	22,2%	13	24,1%
Obesity	1	7,7%	2	8,7%	1	5,6%	4	7,4%
Coronary artery disease	0	0,0%	1	4,3%	0	0,0%	1	1,9%
Diabetes mellitus	2	15,4%	1	4,3%	3	16,7%	6	11,1%

	Group 1: Patients who received neoadjuvant chemotherapy		Group 2: Patients who did not receive chemotherapy		Group 3: Patients who received adjuvant chemotherapy		Total
Total no. of patients	13	100%	23	100%	18	100%	54	100%
Total no. of diagnoses	13	100%	23	100%	19	100%	55	100%
Lobular carcinoma in situ (LCIS)	0	0,0%	6	26,1%	3	15,8%	9	16,4%
Invasive lobular carcinoma (ILC)	2	15,4%	2	8,7%	0	0,0%	4	7,3%
Ductal carcinoma in situ (DCIS)	0	0,0%	3	13,0%	7	36,8%	10	18,2%
Invasive ductal carcinoma (IDC)	11	84,6%	12	52,2%	9	47,4%	32	58,2%
Inflammatory arcinoma (IC)	0	0,0%	0	0,0%	0	0,0%	0	0,0%

	Group 1: Patients who received neoadjuvant chemotherapy		Group 2: Patients who did not receive chemotherapy		Group 3: Patients who received adjuvant chemotherapy		Total
Total no. of patients	13	100%	23	100%	18	100%	54	100%
Total no. of unilat- eral reconstructions	11	84,6%	13	56,5%	13	72,2%	37	68,5%
Total no. of bilateral reconstructions	2	15,4%	10	43,5%	5	27,8%	17	31,5%
Total no. of recon- structions	15	100%	33	100%	23	100%	71	100%
Local flaps	0	0,0%	1	3,0%	1	4,3%	2	2,8%
Prosthesis	0	0,0%	2	6,1%	0	0,0%	2	2,8%
Expanders	6	40,0%	21	63,6%	10	43,5%	37	52,1%
TRAM	5	33,3%	5	15,2%	9	39,1%	19	26,8%
LD	4	26,7%	4	12,1%	3	13,0%	11	15,5%

	Group 1: Patients who received neoadjuvant chemotherapy		Group 2: Patients who did not receive chemotherapy		Group 3: Patients who received adjuvant chemotherapy		Total		Statistical significance
Total no. of patients	13	100%	23	100%	18	100%	54	100%
Total no. of reconstructions	15	100%	33	100%	23	100%	71	100%
Total incidence of complications	6	40%	10	30,3%	11	47,8%	27	38,0%	0,407¹1 Warren Peled A, Itakura K, Foster RD, Hamolsky D, Tanaka J, Ewing C, et al. Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction. Arch Surg. 2010;145(9):880-5.
Minor	5	33,3%	7	21,2%	6	26,1%	18	25,4%	0,667² 2 Chi-square test for the presence or absence of minor complications.
Seroma	2	13,3%	5	15,1%	4	17,4%	11	15,5%
Hematoma	0	0,0%	0	0,0%	1	4,3%	1	1,4%
Dehiscence	2	13,3%	0	0,0%	1	4,3%	3	4,2%
Epidermolysis	1	6,7%	2	6,1%	0	0,0%	3	4,2%
Major	1	6,7%	3	9,1%	5	21,7%	9	12,7%	0,280³ 3 Kruskal-Wallis test for the distribution of the presence or absence of major complications.
Infection	0	0,0%	1	3,0%	2	8,7%	3	4,2%
Necrosis	1	6,7%	2	6,1%	3	13,0%	6	8,5%
PTE	0	0,0%	0	0,0%	0	0,0%	0	0,0%
¹1 Warren Peled A, Itakura K, Foster RD, Hamolsky D, Tanaka J, Ewing C, et al. Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction. Arch Surg. 2010;145(9):880-5.Chi-square test for the	presence or	absence of	complication	s.

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