Plastic Surgery Research Council

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Neo - Adjuvant Chemotherapy is Not Associated With Increased Risk of Complications in Immediate Autologous Breast Reconstruction
Efstathios Karamanos, MD, Ilya Rakitin, MD, Ilan Rubinfeld, MD, FACS, Dunya Atisha, MD.
Henry Ford Hospital/Wayne State University, Detroit, MI, USA.

PURPOSE: Neoadjuvant systemic approaches to breast cancer are increasingly being used for operable disease. Since surgery is generally performed at 2-4 weeks post completion of systemic therapy, the neutropenic window may not be completely overcome, resulting in the risk for increased complications. The purpose of this study is to evaluate the effect of neoadjuvant chemotherapy on post-operative complications in patients undergoing mastectomy with autologous flap reconstruction.
METHODS: All patients undergoing a mastectomy with immediate abdominal flap reconstruction from 2006 - 2016 were identified using the ACS NSQIP database. Demographics, clinical characteristics, lab values and post-operative complications were extracted from the database. Both univariate and multivariate analysis were used to compare complication rates between the neoadjuvant and non-neoadjuvant population.
RESULTS: 1,833 patients were identified as having as mastectomy with immediate abdominal flap reconstruction. Of those, 89 patients received neo - adjuvant chemotherapy (NAC). The NAC cohort were more likely to be younger and have a lower pre - operative WBC, platelet and hematocrit. Multivariate analyses showed that the use of NAC was not associated with higher odds of returning to the OR [AOR (95% CI): 0.5 (0.3, 3.0)], surgical site infections [1.6 (0.7, 3.2)], need for transfusion [1.2 (0.2, 4.5)], wound dehiscence [1.6 (0.3, 6.1)] or development of serious complications [1.3 (0.1, 6.8), figure].
CONCLUSION: Neo - adjuvant chemotherapy is safe in women electing mastectomy with immediate autologous flap reconstruction despite lower pre-operative lab values.


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