PRS AAPS Oral Proofs 2016
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, FACS, FRCSC
From the Washington University in St Louis, St. Louis, Mo.
PURPOSE: Delayed wound healing or infection leads to premature tissue expander (TE) explantation after immediate postmastectomy breast reconstruction. A large study with sufficient duration of follow-up focusing on the impact of chemotherapy on premature TE removal after 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 TEs including neoadjuvant and adjuvant chemotherapy, specific chemotherapeutic regimens, and other factors like cancer stage, body mass index, smoking, radiation, and age. Kaplan-Meier curves were plotted to study the timing of premature TE removal.
RESULTS: Of 899 patients with TEs, 256 received no therapy, 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 TE removal occurred earlier (P = 0.005) in patients who 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 TE occurs more commonly in patients treated with neoadjuvant or adjuvant chemotherapy and is most commonly observed 2 to 3 months after placement—well after the follow-up period recorded by the National Surgical Quality Improvement Program database. These findings can be used to aid preoperative counseling and guide the timing of follow-up for these patients.