Abstract 11. The Effect of Neoadjuvant Chemotherapy Compared to Adjuvant Chemotherapy in Nipple-Sparing Mastectomy

Abstract

Purpose: The impact of neoadjuvant and adjuvant chemotherapy on outcomes in nipple-sparing mastectomy (NSM) have not yet been established. Methods: Patients undergoing NSM from 2006 to June 2015 were identified. Results were analyzed for reconstructions receiving neoadjuvant or adjuvant chemotherapy. Results: Of 840 NSMs, 28 received neoadjuvant chemotherapy while 93 received adjuvant chemotherapy. NSMs with neoadjuvant chemotherapy were significantly more likely to have implant explantation (p=0.0015) and complete nipple necrosis (p=0.0004) compared to those with no chemotherapy. Compared to NSMs with no chemotherapy, those with adjuvant chemotherapy were significantly more likely to have hematoma formation (p=0.0021). Those with neoadjuvant chemotherapy were significantly more likely to have explantation (p=0.0239) and complete nipple necrosis (p=0.0021) compared to those with adjuvant chemotherapy. NSMs with both neoadjuvant and adjuvant chemotherapy were significantly more likely to have complete nipple necrosis compared to those with neoadjuvant chemotherapy only and adjuvant chemotherapy only (p<0.0001). No differences were observed in NSMs with neoadjuvant chemotherapy and adjuvant radiation compared to NSMs with neoadjuvant chemotherapy alone. Conclusions: NSM is safe to perform in the setting of neoadjuvant and adjuvant chemotherapy. However, neoadjuvant chemotherapy appears to increase complications; a synergistic effect between neoadjuvant and adjuvant chemotherapy likely yields overall greatest risk.