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CC BY 4.0 · Arch Plast Surg 2024; 51(05): 466-473
DOI: 10.1055/a-2358-8864
Breast/Trunk: Original Article

Impact of Neoadjuvant Chemotherapy and Preoperative Irradiation on Early Complications in Direct-to-Implant Breast Reconstruction

Ji Won Hwang 
1   Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea
,
Su Min Kim 
1   Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea
,
Jin-Woo Park 
1   Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea
,
Kyong-Je Woo 
1   Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea
2   Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Abstract

Background Impact of previous radiation therapy and neoadjuvant chemotherapy (NACT) on early complications in direct-to-implant (DTI) breast reconstruction has not been elucidated. This study investigated whether DTI reconstruction is viable in patients with NACT or a history of preoperative chest wall irradiation.

Methods Medical records of breast cancer patients who underwent nipple-sparing or skin-sparing mastectomy with DTI breast reconstruction from March 2018 to February 2021, with at least 1 year of follow-up in a single tertiary center, were reviewed. Demographic data, intraoperative details, and postoperative complications, including full-thickness necrosis, infection, and removal, were reviewed. Risk factors suggested by previous literature, including NACT and preoperative chest wall irradiation histories, were reviewed by multivariate analysis.

Results A total of 206 breast cancer patients were included, of which, 9 were bilateral, 8 patients (3.9%) had a history of prior chest wall irradiation, and 17 (8.6%) received NACT. From 215 cases, 11 cases (5.1%) required surgical intervention for full-thickness necrosis, while intravenous antibiotics or hospitalization was needed in 11 cases (5.1%), with 14 cases of failure (6.5%) reported. Using multivariable analysis, preoperative irradiation was found to significantly increase the risk of full-thickness skin necrosis (OR = 12.14, p = 0.034), and reconstruction failure (OR = 13.14, p = 0.005). NACT was not a significant risk factor in any of the above complications.

Conclusion DTI breast reconstruction is a viable option for patients who have received NACT, although reconstructive options should be carefully explored for patients with a history of breast irradiation.

Keywords

direct-to-implant reconstruction - complications - neoadjuvant chemotherapy - prior radiation history

Authors' Contributions

Conceptualization: K-J.W. Methodology: J.W.H., J-W.P., K-J.W. Writing—original draft: J.W.H., K-J.W. Writing—review and editing: S.M.K., J-W.P., K-J.W.


Ethical Approval

This retrospective cohort study was approved by the Institutional Review Board of the Ewha Womans University Mokdong Hospital (No. 2023-02-023).


Patient Consent

Informed consent of the patients was not necessary in this retrospective study.


Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.


Note

This study was presented at Research and Reconstruction Forum, 2023.




Publication History

Received: 31 May 2024

Accepted: 23 June 2024

Accepted Manuscript online:
02 July 2024

Article published online:
06 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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