Neoadjuvant Chemotherapy and Nipple-Sparing Mastectomy: Timing and Postoperative Complications.

Neoadjuvant Chemotherapy and Nipple-Sparing Mastectomy: Timing and Postoperative Complications. - 2019

BACKGROUND: As the demand for nipple-sparing mastectomy (NSM) increases and surgeons expand the eligibility criteria, a subset of patients may become candidates following neoadjuvant chemotherapy (NACT). However, the impact of NACT on postoperative complications remains unclear as the current literature is discordant. CONCLUSIONS: Postoperative complications following NSM in patients completing NACT are comparable with those receiving PS. Patients undergoing NACT do not have a significantly increased risk of necrosis, unintended reoperations, or nipple loss. NACT should not be considered a contraindication for NSM. METHODS: A single-institution, retrospective chart review was performed on patients undergoing NSM from 1989 to 2017. Patient demographics, surgical intervention, systemic treatment, and complication rates were collected. Primary outcomes were 30-day postoperative complications, including nipple-areolar necrosis, skin flap necrosis, infection, wound dehiscence, hematoma, and seroma. Secondary outcomes included characterization of the timing between chemotherapy and surgical intervention, and the impact on complication rates. Each breast was considered independently for analysis, and breasts undergoing either NACT or primary surgery (PS) were compared. RESULTS: Of the 832 breasts included, 88 (10.6%) received NACT and 744 (89.4%) underwent PS. Baseline complication rates were not significantly different between the NACT group and the PS group (5.7% vs. 10.6%; p = 0.119). When controlling for age, body mass index (BMI), smoking, and prior radiation, NACT was not a predictor of complications. Time from completion of NACT to PS occurred at a median of 40.5 days (interquartile range 31.3-55.3), and decreased intervals were not associated with increased complication rates.


English

1068-9265


*Breast Neoplasms/pa [Pathology]
*Carcinoma, Ductal, Breast/pa [Pathology]
*Mastectomy/mt [Methods]
*Neoadjuvant Therapy/mt [Methods]
*Nipples/su [Surgery]
*Organ Sparing Treatments/mt [Methods]
*Postoperative Complications
Adult
Breast Neoplasms/dt [Drug Therapy]
Breast Neoplasms/su [Surgery]
Carcinoma, Ductal, Breast/dt [Drug Therapy]
Carcinoma, Ductal, Breast/su [Surgery]
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Middle Aged
Prognosis
Retrospective Studies


MedStar Washington Hospital Center


Surgery/Plastic Surgery


Journal Article

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