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Original Article Plastic and Aesthetic Research

Effect of neoadjuvant chemotherapy on

skin-sparing mastectomy and breast

reconstruction modalities in 409 patients

Sameh Goubran , Jon Ver Halen 2,3,4
1
1 Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
2 Department of Surgery, Division of Plastic, Reconstructive, and Hand Surgery, Baptist Memorial Healthcare Corporation, Memphis,
TN 38120, USA.
3 Department of Surgery, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA.
4 Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA.
Address for correspondence: Dr. Jon Ver Halen, Division of Plastic and Reconstructive Surgery, Baptist Cancer Center, Vanderbilt Ingram
Cancer Center, St. Jude Children’s Research Hospital, 3268 Duke Circle, TN 38139, USA. E-mail: jpverhalen@gmail.com

ABSTRACT
Aim: While skin-sparing mastectomy (SSM) can be performed in patients with stage II-III breast cancer,
the impact of neoadjuvant chemotherapy (NAC) on SSM rates and reconstructive modalities in these
patients is not known. Methods: Between January 2007 and December 2009, 409 immediate breast
reconstructions (IBRs) were performed in patients with Stage II-III breast cancer. Data were collected on
preoperative, operative, and postoperative factors. Results: There was a statistically significant relationship
between clinical stage of disease and the utilization of SSM or non-SSM (P < 0.0001). Seventy-five percent
of all patients with stage II disease and 50% of patients with stage III disease underwent SSM; similarly,
75.5% of patients with stage II and 49.1% of patients with stage III disease who received NAC underwent
SSM with immediate reconstruction, in spite of having a greater proportion of stage III patients (P < 0.01).
In addition, patients who received NAC followed by SSM with IBR had larger tumors (mean, 3.5 cm vs.
3.1 cm, P < 0.001). The type of IBR, and size of skin defect was significantly affected by whether the
patient underwent SSM or non-SSM (P = 0.001, P < 0.01, respectively). Conclusion: We are increasingly
considering NAC to be an important tool to potentially reduce the morbidity of mastectomy, including
the need to resect breast skin, which can subsequently enhance reconstructive outcomes in patients with
clinical stage II and III breast cancer. Specifically, our data suggest that NAC patients with stage II and
III breast cancer and larger tumors can reliably and safely undergo SSM in nearly half of cases, thus
improving reconstructive outcomes and patient well-being.

Key words:
Immediate breast reconstruction, neoadjuvant chemotherapy, review, skin-sparing mastectomy

INTRODUCTION tumors, NAC has been shown to significantly reduce tumor
size in > 90% of cases, thus increasing the proportion of
The increased use of neoadjuvant chemotherapy (NAC) has patients eligible for breast conservation surgery (BCS).
[1]
altered the therapeutic management of patients with clinical Conversely, in women undergoing mastectomy for early‑stage
stage II and III breast cancer. For patients with large breast breast cancer, skin‑sparing mastectomy (SSM) followed by
immediate breast reconstruction (IBR) has been shown to
Access this article online result in acceptable oncologic and esthetic outcomes and
Quick Response Code: good patient satisfaction. [2‑5] There is increasing evidence
Website: that NAC followed by SSM and postmastectomy radiation
www.parjournal.net
therapy results in favorable long‑term local control and
survival rates. [6,7] It is generally accepted that NAC does not
DOI: increase complication rates after SSM and IBR but that NAC
10.4103/2347-9264.149369 patients undergo IBR and delayed breast reconstruction
with decreased frequency. [8,9] However, it is unclear whether

Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015 17