Effect of neoadjuvant chemotherapy on surgical outcomes in Danish breast cancer patients between 2018-2023

Neoadjuvant chemotherapy (NACT) has been used nationwide in Denmark to downsize tumour and for downstaging of metastases in the axilla. Although several studies have assessed the impact of NACT on surgical complications after immediate breast reconstruction (IBR), the available evidence remains inconsistent. This study investigates the association between NACT and surgical complications after mastectomy with IBR.

This register-based cohort study included patients who underwent mastectomy with IBR between July 2018 and April 2023 at Aarhus University Hospital, Denmark. Data on NACT and postoperative complications were obtained from medical records, covering the period three months postoperatively.

459 IBRs were performed in 341 patients. 53 (11.5%) breasts received NACT. Compared with the non-NACT group, patients in the NACT group were younger (mean age 39.45 versus 46.73 years) and more often underwent two-stage reconstruction with an expander (26.4% versus 9.4%). A total of 279 surgical complications were observed in 28 (52.8%) breasts in the NACT group and 251 (61.8%) breasts in the non-NACT group. After adjusting for confounding factors, no differences in complication rates were found between the two groups except for fewer minor wound complications in the NACT group (18.9% versus 33.3%).

NACT was not associated with an increased risk of postoperative complications following IBR. The lower rate of minor wound complications in the NACT group should be interpreted cautiously, as differences in patient characteristics and residual selection bias may have contributed to this finding. IBR after mastectomy appears feasible in selected patients treated with NACT.