Effect of neoadjuvant chemotherapy on skin-sparing mastectomy and breast reconstruction modalities in 409 patients

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.