4P - Impact of chemotherapy and radiotherapy on tissue expander or implant removal in breast cancer patients

Background

Complications of immediate breast reconstruction caused by chemotherapy or radiotherapy have been debated, but these complications may delay the end of adjuvant treatment and subsequently increase the recurrence. The purpose of this study was to identify risk factors of tissue expander or implant removal and difference of duration from mastectomy to tissue expander or implant removal.

Methods

We conducted a retrospective study of total 11362 breast cancer patients between 2012 and 2017 who were identified in Samsung Medical Center. Eligible patients were total 1091 female breast cancer patients after nipple sparing mastectomy or skin sparing mastectomy with tissue expander or direct implant insertion.

Results

602 (55.2%) patients (group A) have not chemotherapy (CTx), 61 (5.6%) patients (group B) have neoadjuvant CTx and 428 (39.2%) patients (group C) have adjuvant CTx. 897 (82.2%) patients (group D) have not radiotherapy (RTx), 194 (17.8%) patients (group E) have RTx. 1050 (96.2%) patients (group N) have not tissue expander or implant removal and 41 (3.8%) patients (group R) have tissue expander or implant removal. Baseline and pathologic characteristics of patients were not different except N stage between group N and group R. Univariate analysis showed increased pathologic N stage was significantly associated tissue expander or implant removal. (HR = 14.769, 95% CI = 4.338 to 50.284). Tissue expander or implant removal occurred more group B (6.6%) than group A (2.0%) (HR = 3.450, 95% CI = 1.078 to 11.048), more group C (5.8%) than group A (HR = 3.050, 95% CI = 1.515 to 6.141) and more group E (8.8%) than group D (2.7%) (HR = 3.494, 95% CI = 1.839 to 6.639). In multivariate analysis, N stage decreases, tissue expander or implant removal occurred earlier (P < .05). Median time of duration from operation to tissue expander or implant removal was 495 days (range 10-2423 days).

Conclusions

Immediate reconstruction with tissue expander or implant after mastectomy may be a choice of treatment option even in breast cancer patients who will be received chemotherapy or radiotherapy. These results will aid preoperative counselling to patients who are concerned about complication of immediate reconstruction caused by chemotherapy or radiotherapy.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The author.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.