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the use of NAC increases the likelihood that patients those who underwent non‑SSM. There was a statistically
with stage II and III breast cancer will receive SSM with significant relationship between clinical stage of disease
immediate reconstruction, or if it changes the use of and the utilization of SSM or non‑SSM (P < 0.0001).
reconstructive modality. Seventy‑five percent of patients with stage II disease and
50% of patients with stage III disease underwent SSM.
Given the clear preference for skin‑preserving mastectomy
with IBR in the majority of patients undergoing mastectomy, Tumor size also had a significant impact on the utilization
the interaction of these therapeutic options and their of SSM (P = 0.017): patients who underwent SSM had a
impact on outcomes needs to be elucidated. [10‑13] In light of mean tumor size of 3.1 cm (range, 0.5‑14 cm) vs. a mean
the advantages of NAC on improving breast conservation tumor size of 3.9 cm (range, 0.8‑20 cm) for patients who
rates, if applied to patients undergoing mastectomy, it underwent non‑SSM. The authors found a significant
could both allow for more skin preservation and improve difference in the size of excised skin in non‑SSM vs. SSM
2
2
the reconstructive options that can be offered to these patients (56.2 cm vs. 22.3 cm , P < 0.01). As a consequence
patients. [14,15] For patients with clinical stage II‑III breast of the need to replace breast skin, the type of IBR was
cancer who would otherwise not be candidates for SSM, significantly affected by whether the patient underwent
conversion from non‑SSM to SSM allows reconstructive SSM or non‑SSM (P = 0.001). Fifty‑one‑point‑four percent of
surgeons to optimize outcomes due to the preservation of SSM patients ultimately had implant‑based reconstruction,
the three‑dimensional skin envelope, the key component 41.4% had autologous reconstruction, and only 7.2% had a
of an aesthetically acceptable breast reconstruction. latissimus dorsi flap plus a breast implant, vs. 36.8%, 44.4%,
and 18.8% for non‑SSM patients, respectively.
The purpose of this study was to compare the clinical Despite the findings that 57.8% of the SSM patients received
characteristics and outcomes of patients with large NAC and 69.5% of the patients who had NAC underwent
primary and locally advanced breast cancer (stages II SSM, NAC was not shown to have a significant impact on
and III) with or without NAC and IBR after mastectomy. whether a patient underwent SSM or non‑SSM (P = 0.3).
Objectives of this study were to determine the impact of Table 2 compares the clinical characteristics of SSM and
NAC and other clinical factors on the rate of SSM and the non‑SSM patients who underwent NAC. Similar to the
choice of the reconstructive modality in these patients.
listing in Table 1 (which includes all study participants),
75.5% of patients with stage II and 49.1% of patients
METHODS with stage III disease who received NAC underwent SSM

We searched the plastic surgery, breast surgical oncology
and breast medical oncology databases for patients with Table 1: Comparisons of clinical characteristics
stage II‑III breast cancer who underwent IBR. We excluded between patients who underwent SSM and patients
who did not (n = 409)
patients whose records lacked information about the type
of primary surgery or whether the patient had received Characteristics Non-SSM SSM P
NAC. All patients were treated at the same tertiary referral (n = 117) (n = 292)
center. American Joint Committee on Cancer clinical disease Age
stage, patient demographic information, and the side of Mean 48.1 47.3 0.4
the affected breast were recorded for all patients. Data Median (range) 47 (29-76) 48 (23-75)
were collected from clinic notes, patient charts, operative Race
reports, and prospectively entered plastic surgery, medical White 89 (29.1) 217 (70.9) 0.7
oncology, and breast surgical oncology databases. Other 28 (27.2) 75 (72.8)
Clinical TNM stage
For statistical analyzes, patients who underwent IBR were Stage II 87 (24.9) 262 (75.1) < 0.0001
separated into two groups: patients who underwent Stage III 30 (50.0) 30 (50.0)
SSM and patients who underwent non‑SSM. Clinical and Tumor size (cm)
pathological data were tabulated for each of these groups. Mean 3.9 3.1 0.017*
For comparison of all categorical variables, Chi‑square Median (range) 3 (0.8-20) 2.9 (0.5-14)
analysis or Fisher’s exact test (when sample sizes were Neoadjuvant chemotherapy
small) was used. For continuous variables, Student’s t‑test No 43 (25.9) 123 (74.1) 0.3
or the rank sum test (when variances from comparison Yes 74 (30.4) 169 (69.6)
groups were not equal) was used. All P values were Year of surgery
two‑tailed, and we considered P ≤ 0.05 to be significant. 2007 20 (32.3) 42 (67.7) 0.7
Stata statistical software (StataSE 10, StataCorp LP, College 2008 35 (29.9) 82 (70.1)
Station, TX) was used for all statistical analyzes. 2009 62 (27.0) 168 (73.0)
Reconstruction type
Tissue expander followed 43 (36.8) 150 (51.4) 0.001
RESULTS by implant
Autologous 52 (44.4) 121 (41.4)
We identified 409 patients with stage II‑III breast cancer Latissimus dorsi flap 22 (18.8) 21 (7.2)
who met study criteria for inclusion. Table 1 shows the Data are shown as n (%). *Rank sum test. SSM: Skin‑sparing mastectomy,
clinical characteristics of patients who underwent SSM vs. TNM: Tumor node metastasis

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