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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Surgical Outcomes of Prepectoral Two-Stage Breast Reconstruction in Patients Treated with Pembrolizumab or CDK4/6
Yasmine Ibrahim1, Tahera Alnaseri1, Nisha Gupta2
1Division of Plastic and Reconstructive Surgery, University of California - Los Angeles, Los Angeles, CA, USA.
Introduction:
Targeted therapies, including pembrolizumab and CDK4/6 inhibitors, have expanded treatment options for breast cancer subtypes such as triple-negative (TNBC) and hormone receptor-positive/HER2-negative cancers. However, their impact on surgical outcomes in two-stage prepectoral breast reconstruction remains unclear. This study evaluates surgical outcomes in patients receiving pembrolizumab or CDK4/6 inhibitors.
Methods:
A retrospective review was conducted of all patients at a single institution who underwent immediate two-stage prepectoral reconstruction at a single center between January 2018 and October 2024 with ≥3 months of follow-up. Exclusion criteria included autologous, delayed, or direct-to-implant reconstructions, and chemotherapy after implant exchange. Variables analyzed included cancer characteristics, treatments, and postoperative complications. Major complications were defined as those requiring readmission or reoperation. Statistical analyses were performed using Fisher's Exact and Wilcoxon Rank Sum tests.
Results:
Of 472 patients, 27 received pembrolizumab and 30 received CDK4/6 inhibitors. Pembrolizumab had significantly higher seroma rates during expansion (44.4% vs. 27%, p=0.05). After implant exchange, major complications (26.3% vs. 8%, p=0.02) and reoperation rates (19.1% vs. 3.7%, p=0.01) were significantly higher. Patients receiving CDK4/6 inhibitors did not experience an increased risk of infection; in fact, the observed rate of minor infections was lower (0.0% vs. 12.4%, p=0.04), although no significant differences were seen in other outcomes.
Conclusion:
Pembrolizumab is a promising therapy for TNBC, but its association with increased seromas, major complications, and reoperations warrants further investigation. Use of CDK4/6 inhibitors was not associated with an increased risk of infection following tissue expander placement.
Insights
Pembrolizumab use in breast cancer reconstruction increased seroma and reoperation risks. CDK4/6 inhibitors showed no increased infection risk in two-stage prepectoral breast reconstruction.
Area of Science:
- Oncology
- Plastic Surgery
- Surgical Outcomes
Background:
- Targeted therapies like pembrolizumab and CDK4/6 inhibitors offer new breast cancer treatment options.
- Their impact on surgical outcomes in two-stage prepectoral breast reconstruction is not well understood.
Purpose of the Study:
- To evaluate surgical outcomes in patients undergoing two-stage prepectoral breast reconstruction who received pembrolizumab or CDK4/6 inhibitors.
- To compare complication rates between these treatment groups.
Main Methods:
- Retrospective review of 472 patients undergoing immediate two-stage prepectoral reconstruction (January 2018 - October 2024).
- Exclusion of autologous, delayed, or direct-to-implant reconstructions.
- Analysis of cancer characteristics, treatments, and postoperative complications, with major complications defined as requiring readmission or reoperation.
Main Results:
- Pembrolizumab group (27 patients) showed higher seroma rates during expansion (44.4% vs. 27%).
- Major complications (26.3% vs. 8%) and reoperation rates (19.1% vs. 3.7%) were significantly higher after implant exchange in the pembrolizumab group.
- CDK4/6 inhibitor group (30 patients) had no increased infection risk; minor infections were lower (0.0% vs. 12.4%).
Conclusions:
- Pembrolizumab is associated with increased seromas, major complications, and reoperations in two-stage prepectoral breast reconstruction.
- CDK4/6 inhibitors did not elevate infection risk in this patient population.
- Further research is needed to understand pembrolizumab's impact on surgical outcomes.
