Impact of neoadjuvant chemotherapy on rate of tissue expander/implant loss and progression to successful breast reconstruction following mastectomy

Purpose: We examined the frequency and causes of tissue expander (TE) and permanent implant (PI) reconstruction failure in patients undergoing neoadjuvant chemotherapy. Methods and materials: Charts were reviewed from 120 patients with clinical stage II/III breast cancer enrolled between 2004 and 2007 into a prospective clinical trial of neoadjuvant chemotherapy. Patient demographics, tobacco use, radiation treatment, and data relating to the loss of TE, as well as progression to PI and PI loss, were collected. Results: Of 120 patients, 61 underwent 75 mastectomies. Twenty-six patients had 34 TEs placed at the time of mastectomy. Eleven (32%) TEs required removal prior to definitive reconstruction. Fourteen (41%) TEs successfully progressed to PI exchange. Four of the PIs required removal. TE loss occurred most frequently due to infection and extrusion. Radiation, smoking history, or elevated body mass index (BMI) did not significantly affect reconstruction loss. Conclusion: Thirty-eight percent of immediate TEs or PI placements at the time of mastectomy failed to progress to definitive reconstruction in patients receiving neoadjuvant therapy, suggesting that reconstruction with TEs or PI reconstruction should be used cautiously in this patient population.