Cassidy MR, et al. - The impact of response to neo-adjuvant chemotherapy (NAC) on breast reconstruction uptake was determined. In this study, immediate reconstruction (IR) was influenced by age, T-stage at presentation, and choice of bilateral mastectomy, but not by response to NAC, in patients who underwent mastectomy after NAC. Bilateral mastectomy was more frequently observed among a subset of patients who were young, with earlier T-stage and pCR.

Methods

• Researchers reviewed a prospective NAC and mastectomy database with or without reconstruction with IRB approval.
• Kruskal-Wallis or Fisher's exact tests were used to perform univariable analyses.
• To adjust for potential confounders, multivariable logistic regression was used.

Results

• From 9/2013 to 5/2016, 271 patients with unilateral breast cancer receiving NAC and either unilateral or bilateral mastectomy were identified.
• A pCR to NAC was evident in 70 patients (25.8%).
• IR was performed in 175 patients (64.6%), and 96 underwent no IR.
• Univariable analysis revealed that significantly high IR rates were observed in association with younger age (P < .001), lower T-stage at presentation (P < .001), bilateral vs unilateral mastectomy (P<.001) and HR-negative tumor subtype (P=.006).
• Multivariable analysis revealed that pCR (P=.792) and tumor subtype (P=0.061) had no significant association with IR; T-stage had significant association with IR (P < .001), such that patients with T4 tumors at presentation had lower odds of IR (OR 0.10, 95% CI 0.02-0.50), even when accounting for response to NAC.
• Adjuvant radiation therapy was received by 173 patients (63.8%); this was associated with lower IR frequency (P=.048) but was not associated with reconstruction type (tissue expander vs autologous, P=1.0) among 175 patients who had IR.