title: Impact of Neoadjuvant and Adjuvant Chemotherapy on Immediate Tissue Expander Breast Reconstruction.
abstract: 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 (CT) on premature TE removal after immediate breast reconstruction is lacking.
  
  
  
  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 CT, 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.
  
  
  
  Of 899 patients with TEs, 256 received no, 295 neoadjuvant, and 348 adjuvant CT. Premature removal occurred more frequently in the neoadjuvant (17.3 %) and adjuvant (19.9 %) cohorts than the no-CT (12.5 %) cohort (p = 0.056). Premature TE removal occurred earlier (p = 0.005) in patients who received no CT than those with adjuvant CT. Radiation in patients receiving neoadjuvant CT prolonged the mean time to premature removal (p = 0.003). In the absence of radiation, premature removal occurred significantly sooner with neoadjuvant than adjuvant CT (p = 0.035).
  
  
  
  Premature removal of a TE occurs more commonly in patients treated with neoadjuvant or adjuvant CT and is most commonly observed 2-3 months after placement-well after the follow-up period recorded by the American College of Surgeons National Surgery Quality Improvement Program (NSQIP) database. These findings can be used to aid preoperative counseling and guide the timing of follow-up for these patients.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Alvin J Siteman Cancer Center , Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Utku C
authors.initials: UC
authors.lastname: Dolen
authors.affiliation: Division of Plastic and Reconstructive Surgery, Alvin J Siteman Cancer Center , Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Schmidt
authors.affiliation: Division of Plastic and Reconstructive Surgery, Alvin J Siteman Cancer Center , Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Grace T
authors.initials: GT
authors.lastname: Um
authors.affiliation: Division of Plastic and Reconstructive Surgery, Alvin J Siteman Cancer Center , Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Ketan
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Naughton
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Imran
authors.initials: I
authors.lastname: Zoberi
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Margenthaler
authors.affiliation: Division of Plastic and Reconstructive Surgery, Alvin J Siteman Cancer Center , Washington University School of Medicine, St. Louis, MO, USA. myckatynt@wudosis.wustl.edu.
authors.forename: Terence M
authors.initials: TM
authors.lastname: Myckatyn
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D015625:Tissue Expansion Devices