[DOES NEOADJUVANT CHEMOTHERAPY AFFECT THE IMMEDIATE POSTOPERATIVE COMPLICATION RATE AFTER BREAST RECONSTRUCTION?]

Neoadjuvant chemotherapy (NAC) before breast cancer surgery is safe and effective. By reducing the tumor burden, women can achieve complete resections with less extensive operations. Both surgeons and patients share concerns that NAC increases the risk for infection after immediate breast reconstruction, due to its effect on the immune system and the relatively short duration between chemotherapy and surgery. While breast reconstruction plays an increasingly significant role in the treatment of breast cancer, little has been written about the effect of NAC and its impact on post-operative complications.

We identified 158 patients (205 breasts) who underwent surgery for breast cancer with immediate reconstruction between the years 2013-2017 at the Kaplan Medical Center. Using univariate and multivariate statistics, we compared our patient characteristics according to our main predictor of interest: receiving NAC. We focused on the immediate post-operative complications: infection, skin necrosis, wound dehiscence, hematoma, seroma and implant explantation.

Fifty-two patients received NAC and 106 did not. The neoadjuvant group was found to be younger (45 years old vs. 51, P<0.05). The overall complication rate was 30.3%, with a trend towards a lower complication rate in the NAC group, though not statistically significant (23% vs. 34% P=0.2). The overall infection rate was 8.8%, again with a trend towards a lower infection rate among the NAC group (3.8% vs. 11.3% P=0.12). Mastectomy (P=0.02), implant reconstruction (P=0.05) and diabetes (P<0.05) were associated with a higher complication rate.

Our data indicates that NAC is not associated with an increased rate of immediate post-operative complications in women undergoing breast surgery and reconstruction. Therefore, receiving NAC should not be considered a reason to avoid immediate breast reconstruction.