title: Does immediate breast reconstruction after mastectomy and neoadjuvant chemotherapy influence the outcome of patients with non-endocrine responsive breast cancer?
abstract: OBJECTIVE
  In breast cancer (BC) patients, breast surgery followed by immediate breast reconstruction (IBR) might favour recurrences and metastases due to extensive surgical manipulation. We retrospectively investigated whether IBR after mastectomy and neoadjuvant chemotherapy (NT) influenced the outcome in patients with early and locally advanced oestrogen receptor (ER)-negative BC.
  
  
  METHODS
  Between 1995 and 2006, 133 BC patients received NT followed by total mastectomy, 59 of whom underwent IBR. Patients receiving IBR (IBR group) were compared to patients who did not receive IBR (no-IBR group) over a prolonged median follow-up time (8.2 years).
  
  
  RESULTS
  Patients receiving IBR were on average younger than patients not receiving IBR (p<0.001). The percentage of patients with positive clinical nodal status (cN) was 19% in the IBR group and 7% in no-IBR group (p=0.036), whereas patients without IBR were more frequently diagnosed as clinical T4 (59% vs. 15%, p<0.001). The 5-year cumulative incidence of locoregional recurrences were 14% in the no-IBR group and 21% in the IBR group. The hazard of locoregional events, adjusted for age, clinical T and cN, was significantly greater in the IBR group than in the no-IBR group (hazard ratio (HR)=2.77, p=0.045). The 5-year cumulative incidences of distant metastases were similar in the two groups (p=0.414).
  
  
  CONCLUSIONS
  IBR following total mastectomy in patients with ER-negative disease after NT is associated with a worse rate of local relapses. More insight in mechanisms of wound healing and extent of surgery is required to further investigate this observation.
authors.affiliation: European Institute of Oncology, Medical Oncology, Milan, Italy gaetano.aurilio@ieo.it.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Aurilio
authors.affiliation: European Institute of Oncology, Division of Epidemiology and Biostatistics and Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bagnardi
authors.affiliation: European Institute of Oncology, Medical Oncology, Milan, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Graffeo
authors.affiliation: European Institute of Oncology, Medical Oncology, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Nolè
authors.affiliation: European Institute of Oncology, Division of Plastic Reconstruction Surgery, Milan, Italy.
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Petit
authors.affiliation: European Institute of Oncology, Medical Oncology, Milan, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Locatelli
authors.affiliation: European Institute of Oncology, Division of Plastic Reconstruction Surgery, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Martella
authors.affiliation: European Institute of Oncology, Division of Plastic Reconstruction Surgery, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Iera
authors.affiliation: European Institute of Oncology, Division of Plastic Reconstruction Surgery, Milan, Italy.
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Rey
authors.affiliation: European Institute of Oncology, Medical Oncology, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Curigliano
authors.affiliation: European Institute of Oncology, Division of Epidemiology and Biostatistics, Milan, Italy.
authors.forename: Nicole
authors.initials: N
authors.lastname: Rotmensz
authors.affiliation: European Institute of Oncology, Medical Oncology, Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Munzone
authors.affiliation: European Institute of Oncology, Medical Oncology, Milan, Italy.
authors.forename: Aron
authors.initials: A
authors.lastname: Goldhirsch
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000556:secondary / Q000628:therapy; D018275:Carcinoma, Lobular / Q000401:mortality / Q000556:secondary / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D016462:Mammaplasty; D008408:Mastectomy; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D003520:Cyclophosphamide; D008727:Methotrexate; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: Immediate breast reconstruction; invasive breast cancer; locoregional recurrence; non-endocrine responsive patients