Impacts Of Neoadjuvant Chemotherapy On Immediate Breast Reconstruction: A Meta-analysis

BackgroundNeoadjuvant chemotherapy is playing an increasingly significant role inthe treatment of breast cancer. In recent years, many choose to undergoimmediate breast reconstruction. Patients who receive immediatereconstruction have better aesthetic results, a better psychosocial effect.Our concern is whether NAC increases complications after immediatebreast reconstruction.ObjectiveThe objective of this study was to make a meta-analysis of publishedstudies to evaluate the impacts of neoadjuvant chemotherapy (NAC) onimmediate breast reconstruction.MethodsWe searched medical databases for appropriate studies that assessed theimpacts of NAC on immediate breast reconstruction from inceptionthrough April,2013and performed a meta-analysis of the studies. ResultsEleven studies were identified among1840citations. In themeta-analysis, NAC did not increase the overall complication rate afterimmediate breast reconstruction (odd ratio [OR]=0.59;95%confidenceinterval [CI]:0.38-0.91). The complication rate was also not affected byNAC in terms of infection (OR=0.82;95%CI:0.46-1.45), hematoma(OR=1.35;95%CI:0.57-3.21) and seroma (OR=0.77;95%CI:0.23-2.55).Expander/implant (E/I) loss did not significantly increase in patients afterNAC as well (OR=1.59;95%CI:0.91-2.79). Only two studies (202procedures) reporting total autologous flap loss were included in ouranalysis, and both studies found no association of NAC with total flap loss.ConclusionOur analysis suggests that NAC does not increase the complication rateafter immediate breast reconstruction. Immediate breast reconstructionfollowing NAC was a safe procedure for appropriately selected patients. Amulticenter prospective study with longer follow-up period and betterspecified parameters would be the best modality to further study this issue.