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Figure 1: Percentage of patients receiving skin‑sparing mastectomy (SSM) only or SSM with neaoadjuvant chemotherapy, vs. stage of breast cancer, for
years 2007‑2009

cancer. In patients with skin involvement or frank T4b recipients, however, are not more likely to progress to
[7]
disease, NC has enabled an opportunity for SSM in patients delayed reconstruction. Only younger age and lower BMI
where skin involvement regresses clinically. However, seem to predict delayed reconstruction among patients
[20]
little has been studied regarding the effects of NAC on who do not undergo immediate reconstruction.
[27]
IBR. Patients who receive IBR have better esthetic results, Conversely, some patients undergoing NAC may develop
better psychosocial outcomes, and lower costs of surgery treatment fatigue and may be unwilling to undergo
compared to patients who undergo delayed reconstruction elective breast reconstruction. [28]
or no reconstruction. In these patients, SSM has clear There are a number of limitations of our study. Since tissue
[24]
advantages over non‑SSM in that it preserves the breast’s expansion with two‑stage reconstruction can be used for
three dimensional architecture. Furthermore, many patients short of breast skin, a more logical comparison
studies have shown that SSM with IBR does not increase assessing the impact of NAC on SSM‑IBR would evaluate
local or distant recurrence, demonstrating the oncological direct‑to‑implant, one‑stage implant reconstruction. Since
safety of this technique. [2,18] IBR after mastectomy is now we were only beginning to use this technique at the
routinely recommended for selected patients according to time of the study, there were not sufficient patients in
the National Comprehensive Cancer Network Guidelines. the study cohort to examine this subject. In addition, our
[19]
Compared with non‑SSM, SSM is far superior as regards comparison of breast skin specimens (as noted above)
cosmetic outcomes and is expected to remarkably reduce makes this examination unnecessary. Direct comparison
the emotional trauma due to the sense of loss of a breast between NAC and non‑NAC groups was confounded
that is perceived by the patient just after surgery. [25]
because tumor size was statistically larger in the NAC
Although there have been some studies on the group (3.5 cm vs. 3.1 cm for SSM patients), and there was
usefulness of SSM in locally advanced breast cancer, [21,26] a statistically higher proportion of stage III patients in
its application is still debated. It is commonly approved the NAC cohort. Patient cohort size did not permit us to
that local control, prognosis, and risk of complications confine statistical analysis only to patients with tumors
are the same for SSM and NSSM, at least in stages 0, I, larger than 3.5 cm or stage III patients. In addition, most
and II. SSM is still considered to be contraindicated for patients with stage III disease already receive NAC, thus
inflammatory breast cancer and breast cancer with skin confounding this relationship. Of note, the authors found
invasion. So far, no study had addressed the issue an increasing percentage of patients undergoing SSM
[25]
of the influence of clinical characteristics on the type over the course of the study, most notably in Stage III
of breast reconstruction, especially for patients with breast cancer patients [Figure 1]. While this is certainly
advanced breast cancer. We found similar utilization of multifactorial in nature, the use of NAC is a likely
reconstructive modalities between non‑NAC and NAC contributor to this phenomenon. However, a full analysis
cohorts, despite the increased rate of stage III patients of this relationship is beyond the scope of this article.
in the NAC cohort. The authors argue that NAC facilitates Thus, far NAC has mainly been considered by medical
higher stage patients to undergo SSM‑IBR, thus optimizing oncologists as a predictor of response to chemotherapy
care in these patients.
and by breast surgeons as a means to increase eligibility
Previous reports have documented a decreased receipt of for partial mastectomy instead of mastectomy. However,
breast reconstruction in NAC patients. Hu et al. revealed its use to reduce the morbidity of mastectomy in
that recipients of neoadjuvant therapy are less likely to patients with Stage II and III breast cancer, including the
undergo immediate reconstruction, even after controlling need to resect breast skin and subsequently enhance
[27]
for age, disease stage, and receipt of radiotherapy. reconstructive outcomes, is an intriguing possibility. In
They assumed that, the average NAC recipient has a this large single‑center study, we found that NAC did
28% chance of undergoing immediate reconstruction not statistically increase the use of SSM, but did affect
compared with 40% for the average patient who the types of reconstruction used. Further work will help
receives only adjuvant chemotherapy. These neoadjuvant elucidate the role of NAC in IBR.

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