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Original Investigation
June 23, 2021

Association of Clinical Complications of Chemotherapy and Patient-Reported Outcomes After Immediate Breast Reconstruction

Author Affiliations
  • 1Department of Surgery, University of Michigan, Ann Arbor
  • 2Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System, Ann Arbor
  • 3Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor
  • 4Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor
JAMA Surg. 2021;156(9):847-855. doi:10.1001/jamasurg.2021.2239
Key Points

Question  What is the association of chemotherapy with complications and patient-reported outcomes in immediate breast reconstruction?

Findings  In this cohort study of 1881 women undergoing breast reconstruction, the differences in complications and patient-reported outcomes between chemotherapy cohorts were not statistically significant for patients undergoing implant-based or autologous reconstruction.

Meaning  These findings suggest that women undergoing implant-based or autologous breast reconstruction do not have a higher likelihood of complications in the setting of neoadjuvant or adjuvant chemotherapy, and chemotherapy status does not significantly affect satisfaction with reconstruction or psychosocial well-being.


Importance  Women undergoing immediate breast reconstruction often require chemotherapy. The effects of chemotherapy on reconstruction are not well described.

Objective  To evaluate the association of neoadjuvant and adjuvant chemotherapy with complications and patient-reported outcomes (PROs) in immediate reconstruction.

Design, Setting, and Participants  The Mastectomy Reconstruction Outcomes Consortium Study is a cohort study that prospectively assessed PROs and retrospectively evaluated complications in patients undergoing immediate implant-based or autologous reconstruction at 11 centers from January 1, 2012, to December 31, 2017. Women 18 years or older undergoing immediate reconstruction after mastectomy with 2 years of follow-up were included. Patients were excluded if they had prophylactic mastectomy; delayed reconstruction; mixed-timing reconstruction; mixed reconstruction; a latissimus dorsi, superior gluteal artery perforator, or inferior gluteal artery perforator flap; or both neoadjuvant and adjuvant chemotherapy. Data were analyzed from May 1 to June 30, 2018.

Main Outcomes and Measures  Complications and PROs (satisfaction with breast and physical, psychosocial, and sexual well-being) using the BREAST-Q questionnaire, a validated, condition-specific PRO measure. Baseline patient characteristics were collected.

Results  A total of 1881 women were included in the analysis (mean [SD] age, 49.9 [9.9] years). Of these, 1373 (73.0%) underwent implant-based procedures; 508 (27.0%), autologous reconstruction; 200 (10.6%), neoadjuvant chemotherapy; 668 (35.5%), adjuvant chemotherapy; and 1013 (53.9%), no chemotherapy. Patients without chemotherapy were significantly older (mean [SD] age, 51.6 [9.4] years; P < .001), and patients with chemotherapy were more likely to have received radiotherapy (108 of 200 [54.0%] for neoadjuvant chemotherapy and 321 of 668 [48.1%] for adjuvant chemotherapy; P < .001). Among the cohort undergoing implant-based reconstruction, the rates of any complication were significantly different, with higher rates seen for adjuvant (153 of 490 [31.2%]) and neoadjuvant (44 of 153 [28.8%]) chemotherapy compared with no chemotherapy (176 of 730 [24.1%]; P = .02). On multivariable analysis, these differences were not statistically significant. For autologous reconstruction, no significant differences in complications were observed. Controlling for clinical covariates, no significant differences were seen across chemotherapy groups for the BREAST-Q subscales except for sexual well-being in the implant cohort, in which adjuvant chemotherapy had significantly lower scores (β, −4.97 [95% CI, −8.68 to −1.27]; P = .009).

Conclusions and Relevance  In this cohort study, neither neoadjuvant nor adjuvant chemotherapy was associated with the likelihood of complications in patients undergoing implant-based or autologous reconstruction, and chemotherapy was not associated with patient satisfaction with reconstruction or psychosocial well-being. This information can help patients and clinicians make informed decisions about breast reconstruction in the setting of chemotherapy.

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