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Optimal breast reconstruction type for patients treated with neoadjuvant chemotherapy, mastectomy followed by radiation therapy.

Publication ,  Journal Article
Naoum, GE; Oladeru, OT; Niemierko, A; Salama, L; Winograd, J; Colwell, A; Arafat, WO; Smith, B; Ho, A; Taghian, AG
Published in: Breast Cancer Res Treat
August 2020

PURPOSE: To explore the optimal type of breast reconstruction and the time interval to postmastectomy radiotherapy (PMRT) associated with lower complications in breast cancer patients receiving neoadjuvant chemotherapy. METHODS: We reviewed the medical records of 300 patients who received neoadjuvant chemotherapy, mastectomy with breast reconstruction and PMRT at our institution from 2000 to 2017. Reconstruction types included autologous flaps (AR), single-stage-direct-to-implant and two-stages expander/implant (TE/I). The primary endpoint was the rate of reconstruction complications including infection, skin and fat necrosis. Subgroup analysis compared rates of capsular contracture, implant rupture, implant exposure and overall implant failure in single-stage-direct-to-implant to TE/I. The secondary endpoint was identifying the time interval between surgery with immediate implant-based reconstruction and PMRT associated with lower probability of implant failure. Logistic regression models, Kaplan-Meier estimates and Polynomial regression were used to assess endpoints. RESULTS: The median follow-up was 43.5 months. 29.3%, 28.3% and 42.4% of the cohort had AR, TE/I and single-stage-direct-to-implant D, respectively. The 5-year cumulative incidence rate of complications was 14.0%, 29.7% and 19.4% for AR, TE/I and single-stage-direct-to-implant, respectively (Log rank p = 0.02). Multivariate analysis showed significant association between TE/I and higher risk of infection (OR 8.1, p = 0.009) compared to AR, while single-stage-direct-to-implant and AR were comparable (OR 3.2, p = 0.2). On subgroup analysis, TE/I was significantly associated with higher rates of implant failure. The mean wait time to deliver PMRT after immediate reconstruction with no adjuvant chemotherapy was 8.4 and 10.7 weeks in single-stage-direct-to-implant and TE/I, respectively (p < 0.005). Delivering PMRT after 8 weeks of surgery yielded 10% probability of reconstruction failure in single-stage-direct-to-implant versus 40% in TE/I. CONCLUSION: In comparison to two stages reconstruction, single-stage-direct-to-implant following neoadjuvant chemotherapy has lower complications and offers timely delivery of PMRT.

Duke Scholars

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Published In

Breast Cancer Res Treat

DOI

EISSN

1573-7217

Publication Date

August 2020

Volume

183

Issue

1

Start / End Page

127 / 136

Location

Netherlands

Related Subject Headings

  • Tissue Expansion Devices
  • Surgical Wound Infection
  • Surgical Flaps
  • Seroma
  • Radiotherapy, Adjuvant
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Middle Aged
  • Mastectomy
  • Mammaplasty
 

Citation

APA
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MLA
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Naoum, G. E., Oladeru, O. T., Niemierko, A., Salama, L., Winograd, J., Colwell, A., … Taghian, A. G. (2020). Optimal breast reconstruction type for patients treated with neoadjuvant chemotherapy, mastectomy followed by radiation therapy. Breast Cancer Res Treat, 183(1), 127–136. https://doi.org/10.1007/s10549-020-05747-7
Naoum, George E., Oluwadamilola T. Oladeru, Andrzej Niemierko, Laura Salama, Jonathan Winograd, Amy Colwell, Waleed O. Arafat, Barbara Smith, Alice Ho, and Alphonse G. Taghian. “Optimal breast reconstruction type for patients treated with neoadjuvant chemotherapy, mastectomy followed by radiation therapy.Breast Cancer Res Treat 183, no. 1 (August 2020): 127–36. https://doi.org/10.1007/s10549-020-05747-7.
Naoum GE, Oladeru OT, Niemierko A, Salama L, Winograd J, Colwell A, et al. Optimal breast reconstruction type for patients treated with neoadjuvant chemotherapy, mastectomy followed by radiation therapy. Breast Cancer Res Treat. 2020 Aug;183(1):127–36.
Naoum, George E., et al. “Optimal breast reconstruction type for patients treated with neoadjuvant chemotherapy, mastectomy followed by radiation therapy.Breast Cancer Res Treat, vol. 183, no. 1, Aug. 2020, pp. 127–36. Pubmed, doi:10.1007/s10549-020-05747-7.
Naoum GE, Oladeru OT, Niemierko A, Salama L, Winograd J, Colwell A, Arafat WO, Smith B, Ho A, Taghian AG. Optimal breast reconstruction type for patients treated with neoadjuvant chemotherapy, mastectomy followed by radiation therapy. Breast Cancer Res Treat. 2020 Aug;183(1):127–136.
Journal cover image

Published In

Breast Cancer Res Treat

DOI

EISSN

1573-7217

Publication Date

August 2020

Volume

183

Issue

1

Start / End Page

127 / 136

Location

Netherlands

Related Subject Headings

  • Tissue Expansion Devices
  • Surgical Wound Infection
  • Surgical Flaps
  • Seroma
  • Radiotherapy, Adjuvant
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Middle Aged
  • Mastectomy
  • Mammaplasty