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Effect Of Neoadjuvant Chemotherapy On Autologous Breast Reconstruction: A Systematic Review
Kanad Ghosh, MD, Maxwell Wang, MD, Summer Hanson, MD, PhD, David Chang, MD, Maureen Beederman, MD.
University of Chicago Medical Center, Chicago, IL, USA.
PURPOSE: While the efficacy of chemotherapy in improving oncologic outcomes has been established, it also has several side effects. Our study reviews current data regarding complications of neoadjuvant chemotherapy (NACT) in autologous breast reconstruction.
METHODS: A systematic review was performed using Medline, EMBASE, and Cochrane databases. Included studies evaluated complications of patients undergoing NACT followed by mastectomy and immediate autologous breast reconstruction.
RESULTS:4,873 studies underwent screening. 11 studies of 2,586 patients were included. 735 patients (28.4%) underwent NACT whereas 1,851 patients (71.6%) did not. The average age for the NACT cohort was 45.9 years ± 3.7 and 50.2 years ± 4.1 for the control group. The overall complication rate was 155/583 (26.6%) in reported NACT patients, and 290/861 (33.7%) in reported control patients. Of the NACT cohort, hematoma occurred in 19/623 (3.0%), wound dehiscence occurred in 33/303 (10.9%), infection occurred in 30/561 (5.4%), fat necrosis occurred in 41/178 (23.0%), and seroma occurred in 24/496 (4.8%) of patients. Of the non-NACT cohort, hematoma occurred in 61/977 (6.2%), wound dehiscence occurred in 100/861 (11.6%), infection occurred in 85/1,568 (5.4%), fat necrosis occurred in 61/335 (18.2%), and seroma occurred in 70/977 (7.2%) of patients. Partial or total flap loss was reported in 20/462 (4.3%) of NACT patients and 43/1,359 (3.2%) of control patients.
CONCLUSION: In a review of data, complication profiles between patients undergoing autologous reconstruction with history of NACT and control patients were relatively similar. Further work to evaluate the effects of chemotherapy will progress safe management of breast reconstruction patients
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