The Effect of Neoadjuvant Chemotherapy on Implant Loss in Immediate Tissue Expander-Based Breast Reconstruction

Implant-based reconstruction represents the most common method of breast reconstruction today. Many surgeons approach implant-based breast reconstruction in 2 stages, with the first stage being placement of a tissue expander at the time of mastectomy. Neoadjuvant chemotherapy can have systemic effects that may place patients at risk for TE/implant loss, infection, wound, and other complications.

A retrospective review of all cases of TE breast reconstruction at a single institution between 2017 and 2024 was performed. A total of 210 patients, representing 319 total breasts that underwent reconstruction, met the inclusion criteria. Sixty-five patients underwent neoadjuvant chemotherapy and 145 did not. Patients were separated into neoadjuvant chemotherapy (NACT) and nonneoadjuvant chemotherapy (non-NACT) cohorts. Primary outcomes of TE loss, wound, infection, and seroma were analyzed. Regression analysis was performed, matching patients for known risk factors.

The rate of all-cause TE loss in patients who underwent NACT was 18%, and 11% for patients who did not. The rate of pathologic TE loss was significantly higher at 14% in patients who underwent NACT and 7% in patients who did not undergo NACT ( P =0.032). On regression analysis, neoadjuvant chemotherapy increased the rate of all-cause and pathologic TE loss by 17% ( P <0.05). There were no statistically significant differences in wound, seroma, and infection.

In this study, neoadjuvant chemotherapy is an independent risk factor for TE loss after immediate tissue expander-based breast reconstruction. Further analysis of adjuncts, implant factors, and specific chemotherapeutic agents is needed.