The Breast:
VOLUME 55, P55-62, FEBRUARY 01,
2021
by Jajini Varghese, Shireen S. Gohari, Hirah Rizki, F.R.C.S.
ichael Faheem, Benjamin Langridge, Sherko Kümmel, Laura Johnson, Peter Schmid
Background
The impact of neoadjuvant chemotherapy (NACT) on surgical
outcomes following immediate breast reconstruction (IBR) remains unclear. While
it is generally considered safe practice to perform an IBR post NACT, reported
complication rates in published data are highly variable with the majority of
studies including fewer than 50 patients in the NACT and IBR arm. To evaluate this
further, we conducted a systematic review and meta-analysis on the effect of
NACT on autologous and implant based immediate breast reconstructions. We aimed
to assess for differences in the post-operative course following IBR between
patients who received NACT with those who did not.
Methods
PubMed, EMBASE, and Cochrane Library were searched from 1995
to Sept 2, 2020 to identify articles that assessed the impact of NACT on IBR.
All included studies assessed outcomes following IBR. Only studies comparing
reconstructed patients receiving NACT to a control group of women who did not
receive NACT were included. Unadjusted relative risk of outcomes between
patients who received or did not receive NACT were synthesized using a
fixed-effect meta-analysis. The evidence was assessed using the Newcastle
Ottawa Scale scores and GRADE. Primary effect measures were risk ratios (RRs)
with 95% confidence intervals.
Results
A total 17 studies comprising 3249 patients were included in
the meta-analyses. Overall, NACT did not increase the risk of complications
after immediate breast reconstructions (risk ratio [RR]: 0.91, 95% CI 0.74 to
1.11, p = 0.34). There was a moderate, but not significant,
increase in flap loss following NACT compared with controls (RR: 1.23, 95% CI 0.70
to 2.18, p = 0.47; I2 = 0%). Most notably, there
was a statistically significant increase in implant/expander loss after NACT
(RR: 1.54, 95% CI 1.04 to 2.29, p = 0.03; I2 = 34%).
NACT was not shown to significantly increase the incidence of hematomas,
seromas or wound complications, or result in a significant delay to commencing
adjuvant therapy (RR: 1.59, 95% CI 0.66 to 3.87, p = 0.30).
Conclusion
Immediate breast reconstruction after NACT is a safe
procedure with an acceptable post-operative complication profile. It may result
in a slight increase in implant loss rates, but it does not delay commencing
adjuvant therapy.
