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2010 Annual Meeting Abstracts

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Impact of Neoadjuvant Chemotherapy on Breast Reconstruction
*Yue-Yung Hu1, *Christine M. Weeks1, *Haejin In1, *Christopher M. Dodgion1, *Mehra Golshan1, *Yoon S. Chun1, *Michael J. Hassett2, *Xiangmei Gu1, *Stuart R. Lipsitz1, *Caprice C. Greenberg1
1Brigham & Women's Hospital, Boston, MA;2Dana Farber Cancer Institute, Boston, MA

Objective: To investigate the influence of neoadjuvant chemotherapy on breast reconstruction.
Design: Retrospective cohort study.
Setting: Large, tertiary-care institution.
Patients: 684 patients with stage I-III cancer who underwent chemotherapy and mastectomy at Dana-Farber/Brigham & Women’s Cancer Center in 1997-2007.
Intervention: Neoadjuvant chemotherapy and/or immediate (same day as mastectomy) or delayed (after mastectomy) reconstruction.
Main Outcome Measures: Rates of reconstruction were compared for recipients of neoadjuvant chemotherapy (n=180) and adjuvant-only chemotherapy (n=504) using multivariate logistic regression. Rates of postoperative complications following neoadjuvant chemotherapy were also determined.
Results: Recipients of neoadjuvant therapy were reconstructed at a rate of 42%, compared to 56% of patients receiving only adjuvant chemotherapy. Reconstruction was performed immediately in 23% v. 44%, while 19% v. 12% received delayed reconstruction. After controlling for age, receipt of radiotherapy, and stage, neoadjuvant recipients were less likely to have immediate reconstruction (OR 0.59, 95% CI 0.38, 0.91), and, if not immediately reconstructed, were not significantly more likely to undergo delayed reconstruction (OR 1.31, 95% CI 0.75, 2.29). There was no association between neoadjuvant chemotherapy-related complications and receipt of reconstruction. Surgical complications occurred in 36% of neoadjuvant recipients. Although this rate was higher in patients who received immediate reconstruction compared to those who did not, the difference was not significant on univariate (45% v. 33%, p=0.20) or multivariate analyses.
Conclusions: Patients receiving neoadjuvant chemotherapy are less likely to have immediate reconstruction, and are no more likely to receive delayed reconstruction, than patients who undergo an operation before chemotherapy. While further study is needed to understand the etiology, this information should be incorporated into treatment decisions regarding timing of chemotherapy and surgery to optimize clinical outcome.

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