Oncologic outcomes of immediate breast reconstruction in young women with breast cancer receiving neoadjuvant chemotherapy

• Published in: Breast cancer research and treatment 2022, Vol.191 (2), p.345-354
• Main Authors: Wu, Zhen-Yu, Kim, Hee Jeong, Lee, Jongwon, Chung, Il Yong, Kim, Jisun, Lee, Sae Byul, Son, Byung-Ho, Kim, Eun Key, Jeong, Jae Ho, Lee, Hee Jin, Chae, Eun Young, Jung, Jinhong, Ahn, Sei-Hyun, Ko, BeomSeok
• Format: Article
• Language: English
• Subjects: Adjuvant treatment; Adult; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - surgery; Cancer; Cancer patients; Cancer research; Chemotherapy; Clinical Trial; Comparative analysis; Diseases; Female; Humans; Mammaplasty; Mastectomy; Medical colleges; Medicine; Medicine & Public Health; Metastases; Metastasis; Neoadjuvant Therapy; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - surgery; Oncology; Patients; Radiation therapy; Radiotherapy; Relapse; Retrospective Studies; Survival; Young women
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-021-06428-9

Background Oncologic safety of postmastectomy breast reconstruction in young women with breast cancer is not well-defined, especially in the setting of neoadjuvant chemotherapy (NACT). We retrospectively compared the oncologic outcomes following nipple-sparing (NSM)/skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) and conventional mastectomy (CM) alone in young breast cancer patients after NACT. Methods A total of 1266 women with primary breast cancer who underwent NACT followed by total mastectomy with or without IBR were reviewed. Of these, only young patients (age ≤ 40 years at diagnosis) were included in the outcome analysis ( n  = 375). After propensity score-matching by clinical T and N stage, molecular subtype, response to NACT, and adjuvant radiotherapy status, 228 patients were 1:1 matched, comprising balanced IBR group (with NSM/SSM) and CM-alone group. Results The 5-year locoregional recurrence-free, disease-free, distant metastasis (DM)-free, and breast cancer-specific survival (BCSS) rates for the entire cohort of young patients were 83.4%, 65.3%, 71.7%, and 85.4%, respectively. Locoregional recurrence rates between the matched groups were similar (14% vs. 15.8%; p  = 0.710); however, IBR group had significantly lower DM rate (27.2% vs. 40.4%; p  = 0.036) and breast cancer mortality (14.9% vs. 27.2%; p  = 0.023) than CM-alone group. IBR group showed significantly improved 5-year DM-free survival (74.1% vs. 62.6%; p  = 0.043) and BCSS (89.1% vs. 77.6%; p  = 0.048) rates than CM-alone group. Conclusions Our results indicated that IBR with NSM/SSM does not negatively affect long-term oncologic outcomes compared to CM alone in young women with breast cancer receiving NACT.