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The Impact Of Neoadjuvant And Adjuvant Chemotherapy On Immediate Tissue Expander Breast Reconstruction
Utku C. Dolen, MD, Alexandra C. Schmidt, MD, Grace T. Um, MD, Ketan Sharma, MD, Michael Naughton, MD, Imran Zoberi, MD, Julie M. Margenthaler, MD, FACS, Terence M. Myckatyn, MD, Assoc, Prof.,FACS, FRCSC.
Washington University in St Louis, St. Louis, MO, USA.

Purpose. Delayed wound healing or infection leads to premature tissue expander explantation following immediate post-mastectomy breast reconstruction. A large study with sufficient duration of follow-up focusing on the impact of chemotherapy on premature tissue expander removal following immediate breast reconstruction is lacking.
Methods. A retrospective review of patients undergoing immediate TE reconstruction was conducted. Multivariate analyses identified factors contributing to premature removal of tissue expanders including neoadjuvant and adjuvant chemotherapy, specific chemotherapeutic regimens, and other factors like cancer stage, BMI, smoking, radiation, and age. Kaplan-Meier curves were plotted to study the timing of premature TE removal.
Results. Of 899 patients with tissue expanders, 256 received no, 295 neoadjuvant, and 348 adjuvant chemotherapy. Premature removal occurred more frequently in the neoadjuvant (17.3%) and adjuvant (19.9%) cohorts than the no chemotherapy (12.5%) cohort (p= 0.056). Premature tissue expander removal occurred earlier (p= 0.005) in patients that received no chemotherapy than those with adjuvant chemotherapy. Radiation in patients receiving neoadjuvant chemotherapy prolonged the mean time to premature removal (p= 0.003). In the absence of radiation, premature removal occurred significantly sooner with neoadjuvant than adjuvant chemotherapy (p= 0.035).
Conclusions. Premature removal of a tissue expander occurs more commonly in patients treated with neoadjuvant or adjuvant chemotherapy and is most commonly observed two to three months following placement - well after the follow-up period recorded by the NSQIP database. These findings can be used to aid preoperative counseling and guide the timing of follow-up for these patients.


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