Work

One-year surgical complications and cosmetic outcomes of neoadjuvant/adjuvant chemotherapy in reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant reconstruction

Year: 2025

Type: article

Abstract: BACKGROUND: The reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with direct-to-implant breast reconstruction (DIBR) is increasingly popular in China. It is critical to assess the impact of chemotherapy on postoperative outcomes. STUDY DESIGN: A prospective cohort study was conducted between April 2020 and December 2023 at the Breast Center, West China Hospital, Sichuan University. Patients were followed for complications and cosmetic outcomes for at least 12 months post-surgery. RESULTS: A total of 692 patients were enrolled: 241 (34.8%) received no chemotherapy (NC), 113 (16.3%) underwent neoadjuvant chemotherapy (NAC), and 338 (48.8%) received adjuvant chemotherapy (AC). Compared to the NC group, the AC group had higher rates of Clavien-Dindo classification (CDC) ≥2 complications [20.7% vs. 12.6%, 1.820 (1.144-2.895), P = 0.036] and Surgical site infection [SSI; 18.0% vs. 8.8%, 2.240 (1.322-3.797), P = 0.003]. Further analysis revealed that most complications occurred within 30 days (any, CDC ≥ 2, SSI, P < 0.05). Multivariable analysis showed a significant increase in any complications over time [OR, 1.680 (95% CI, 1.015-2.711), P = 0.044] and SSI after 30 days [OR, 2.346 (95% CI, 0.991-5.556), P = 0.052] in the AC group. After controlling for clinical covariates, no significant differences were observed among the NAC, NC, and AC groups in the BREAST-Q subscales and Ueda score. CONCLUSIONS: In R-E-NSM with DIBR, compared to AC, NAC was associated with a lower overall risk of postoperative complications. Neither NAC nor AC impaired patient- or physician-reported cosmetic outcomes. These results suggest that NAC may be preferable for chemotherapy patients with implant reconstruction but require validation in larger, longer-term studies.

Source: International Journal of Surgery

DOI: 10.1097/js9.0000000000003874