Immediate Breast Reconstruction Group Research Articles

Oncologic Outcomes of Immediate Breast Reconstruction in the Setting of Neoadjuvant Chemotherapy: A Long-term Follow-up Study of a Matched Cohort.

Despite the increasing use of immediate breast reconstruction (IBR), its oncologic safety in the setting of neoadjuvant chemotherapy (NACT) needs to be comprehensively clarified in breast cancer management. The objective of the present study was to analyze the oncologic safety of IBR following NACT. In total, 587 patients with breast cancer who underwent a total mastectomy (TM) with IBR after NACT between 2008 and 2017 at a single institution were retrospectively reviewed. The reviewed patients with IBR following skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) were matched 1:3 to patients who underwent TM alone after NACT. Matching variables included age, clinical T and N stages before NACT, response to NACT, pathologic T and N stages, and molecular subtypes. After propensity score matching, 95 patients who underwent IBR following SSM/NSM after NACT (IBR group) and 228 patients who underwent TM alone after NACT (TM group) were selected. The median follow-up period was 73 (range, 5-181) months after matching. After matching, there were no significant differences between the two groups in 5-year locoregional recurrence-free survival (88.8% vs. 91.2%, p = 0.516), disease-free survival (67.3% vs. 76.6%, p = 0.099), distant metastasis-free survival (71.9% vs. 81.9%, p = 0.057), or overall survival (84.1% vs. 91.5, p = 0.061) rates. In multivariate analyses, conducting IBR was not associated with increased risks for locoregional recurrence, any recurrence, distant metastasis, or overall death. Our findings suggest that IBR following SSM/NSM elicits comparable long-term oncologic outcomes to those of TM alone in the setting of NACT.

Effect of Breast Reconstruction on Breast Cancer Therapy.

Few studies have examined the effect of immediate breast reconstruction (IBR) on the overall progression of breast cancer therapy. This study examins the effect of IBR on the breast cancer therapy. 142 patients underwent mastectomy in our department (With IBR group, n = 17; Without IBR group, n = 125). We examined the number of days from diagnosis to surgery, operation time, length of postoperative stay, number of days from surgery to postoperative therapy, and complications in patients with or without breast reconstruction and by type of reconstruction. In the IBR group, the operation time was longer (P < 0.001), postoperative hospital stay was longer when adjusted for multivariate analysis (P = 0.008), and complications were significantly more common (P < 0.001), but there was no significant difference when limited to grade ≥3 complications. There was no difference until the start of postoperative treatment. The results reveal that IBR requires coordination between the surgical and operating room staff, and does not affect the transition to postoperative treatment but does affect an increased incidence of minor complications and length of postoperative stay.

Mastectomies for breast cancer: Comparison between peri-operative morbidity after simple mastectomy or after immediate breast reconstruction in a unicentric serie of 210 patients

BackgroundIn breast cancer surgery, IBR (immediate breast reconstruction) is widely proposed to patients without indications of adjuvant treatments and without risk factors of surgical complications. New INCa's guidelines (2022) allow the expansion of IBR indications. ObjectiveA retrospective, unicentric and safety study: post-operative complication rate after IBR in comparison with simple mastectomy (SM, reference treatment). Materiel and methodThis retrospective study has included all major patients who have received mastectomy for breast cancer between 2016 and 2020 before application of new guidelines, in Hôpital de la Croix-Rousse, Lyon (France). They were distributed in two groups according to their surgery : IBR and SM. Usual risk factors of post-operative complications were collected (tabacco, obesity…). The primary endpoint was the occurrence of an early post-operative complication (within 3 months after surgery). Two secondary analysis focused on the impact of preoperative risk factors on complications, and the proportion of patients eligibled for an IBR among SM based on new INCA's guidelines. ResultsThe study included 185 mastectomies: 153 SM, 32 mastectomies IBR. IBR's patients presented less risk factors, and few indications of adjuvant treatments. The rate of major complications was identical in the two groups (14 % in SM group, 12 % in IBR group), and there were more minor complications in the SM group than in the IBR group (p 0,01). According to our study, the raw proportion of initially possible IBR was 68 % (36 % of breast reconstruction in this study). ConclusionThis analyse approve IBR in selected patients. In this context, INCa's guidelines (2022) can generalize IBR's proposal to patients. However, the analysis of pre-operative risk factors stay essential in medical care.

Prognosis of post-neoadjuvant therapy patients who underwent immediate breast reconstruction: a SEER-based, propensity-matched study

ObjectiveThe application of immediate breast reconstruction (IBR) for post-neoadjuvant therapy (NAT) patients was controversial. The aim of this study was to investigate the long-term survival outcomes of IBR for these patients.MethodsData between January 2010 and November 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to reduce the influence of confounding factors between the mastectomy alone group (MA) and the mastectomy with IBR group (IBR). The rates of 5 year breast cancer-specific survival (BCSS) were compared by Kaplan–Meier curves with log-rank test.ResultsThe IBR was associated with improved 5-year BCSS in the IBR group before PSM (88.5 vs. 79.1%, P < 0.001). The proportion of IBR increased from 21.5% in 2010 to 28.2% in 2017. After PSM, a total of 9,610 patients were enrolled for survival analysis (4,805 in each group). In the complete response (CR) group, the 5-year BCSS rates did not differ (93.4 vs. 95.6%, P = 0.16). In the non-CR group, the 5-year BCSS rate was higher in patients who received IBR (82.5% 79.4%, P = 0.034).ConclusionIn general, the application of IBR among post-NAT patients has steadily increased from 2010 to 2017. In the CR group, survival outcomes of post-NAT patients who received IBR were similar to those who received mastectomy alone. In the non-CR group, IBR was associated with potential survival benefits. More studies are expected to validate our findings.

Delay in the initiation of adjuvant chemotherapy in patients with breast cancer with mastectomy with or without immediate breast reconstruction.

BackgroundPatients with breast cancer undergoing mastectomy should be offered the option of immediate breast reconstruction (IBR). The aim of this retrospective study was to assess whether there is a delay in the initiation of adjuvant chemotherapy in patients undergoing mastectomy with or without IBR.MethodThe study included patients aged 70 years or younger with clinically node-negative breast cancer who underwent unilateral mastectomy with IBR (IBR group) or mastectomy alone (no-IBR group) followed by adjuvant chemotherapy at the Helsinki University Hospital between January 2012 to July 2018.ResultsA total of 645 patients were included; 186 in the IBR group and 459 in the no-IBR group. Sixty-six (35.5 per cent) patients in the IBR group and 102 (22.2 per cent) patients in the no-IBR group received their first chemotherapy cycle later than 6 weeks after surgery (P < 0.001). The respective numbers for later than 8 weeks were 17 (9.1 per cent) and 14 (3.1 per cent) (P = 0.001). Among all 645 patients, postoperative complications were a significant risk factor for a delay in the initiation of chemotherapy. Sixty-seven (39.9 per cent) patients with and 101 (21.2 per cent) patients without complications had a delay in chemotherapy (P < 0.001). The delay in chemotherapy was due to complications in 39 (59.1 per cent) in the IBR group and in 28 (27.5 per cent) in the no-IBR group (P < 0.001).ConclusionPatients undergoing mastectomy alone were more likely to receive adjuvant chemotherapy within 6 weeks after surgery compared with the IBR patients. IBR significantly increased the risk of postoperative complications in comparison with mastectomy alone. The complications, in turn, were a significant risk factor for delay in adjuvant chemotherapy.

119. A Prospective Evaluation of Breast Cancer Patient Perception of the Physical Wellbeing of the Chest

Purpose: Surgical management options for breast cancer, including breast-conserving therapy, mastectomy alone, and mastectomy with immediate or delayed breast reconstruction, have the potential for associated chest and upper body morbidity including chronic pain, paresthesia, and impairment of shoulder and arm mobility. The primary aim of this study is to prospectively evaluate chest and upper body physical well-being in women with breast cancer before and following three surgical approaches: breast conserving surgery (BCS), mastectomy alone (MA), and mastectomy with immediate breast reconstruction (IBR). Methods: A prospective cohort study of women with stage 0-III breast cancer was conducted at University Health Network in Toronto, Canada between 2014- 2020. The primary outcome was BREAST-Q chest physical well-being subdomain, completed pre-operatively (T0), and at 6- and 12-months following surgery (T1 and T2, respectively). Change in chest well-being scores was assessed between surgical groups (BCS, MA, IBR) using linear mixed models, controlling for age, ethnicity, and adjuvant treatments. P values <.05 were considered significant. Results: In the overall cohort, 452 patients were identified. Of those patients, 197 (43.6%) underwent BCS, 122 (27%) underwent MA, and 133 (29.4%) underwent IBR. There was a significant interaction (P<0.01) between surgical intervention and time for chest well-being after adjusting for age, ethnicity, chemotherapy, radiotherapy and endocrine therapy. At baseline, BCS patients had significantly higher BREAST-Q chest physical well-being scores with a median (IQR) score of 100 (80,100) compared with MA and IBR groups with median scores of 76 (66,85) and 81 (68,91), respectively (P<0.0001). At T1, while there was no significant difference between BCS and IBR groups with medians of 72 (59,81) and 68 (60,77), respectively, both groups had significantly higher scores compared with MA patients with median scores of 60 (53,71) (P<0.0001). This trend was sustained at T2, with BCS and IBR having median scores of 72 (64,86) and 74 (63,81), respectively, compared with MA having a median score of 63 (53,74) (P<0.0001). Within-group comparisons revealed significantly higher BCS scores at T0 compared with T1 and T2 (P<0.0001), with no significant difference between T1 and T2. A similar trend was also noted in the IBR group with higher baseline scores compared with T1 and T2 (P<0.0001), and no significant difference between T1 and T2. Conversely, in the MA group, there was a significant decrease in median scores from T0 76 (66,85) to T1 60 (53,71) (P<0.0001); scores did improve at T2 63 (53,74) (P=0.028) but did not return to T0 levels (P=0.018). Conclusion: Chest physical well-being decreases in breast cancer patients after undergoing surgical intervention, as seen in all three surgical groups. Patients that perceive their baseline chest physical well-being more positively may be more inclined to undergo breast conservation. Women undergoing mastectomy alone experience the greatest decreases in chest physical well-being. Moreover, immediate breast reconstruction at the time of mastectomy appears to improve chest physical well-being. These data should be considered by women having mastectomy for breast cancer treatment and wishing to optimize their future chest physical well-being.

A Single-Center Retrospective Analysis of Local and Distant Relapse of Breast Cancer Following Immediate Breast Reconstruction According to Molecular Subtypes.

PurposeConcerns have been raised about the oncologic safety of immediate breast reconstruction (IBR) following mastectomy for breast cancer. This study aimed to evaluate locoregional recurrence (LRR) and distant metastasis (DM) of breast cancer according to its molecular subtype in patients who underwent mastectomy alone or IBR after mastectomy.MethodsIn this retrospective cohort study, consecutive breast cancer patients treated by the single senior surgeon (XZ) between February 2010 and December 2014 were eligible. In total, 389 consecutive patients were included; 295 patients underwent mastectomy alone and 94 patients underwent mastectomy with IBR. Data were retrospectively collected and analyzed for LRR and DM stratified by molecular subtypes.ResultsWith a median follow-up of 73 and 87.5 months, 1.69% of patients in the mastectomy alone group developed LRR compared to 0% in the reconstruction group (p = 0.342) and the total incidence of DMs was 11.52% in patients who received mastectomy alone and 7.44% in patients who received postmastectomy IBR (p = 0.262), respectively. The cumulative incidence of LRR was 2.1% vs. 0% for luminal A, 0% vs. 0% for luminal B, 0% vs. 0% for human epidermal growth factor receptor 2 (HER2)-enriched, and 4.5% vs. 0% for triple-negative in the mastectomy alone group compared to the postmastectomy IBR group. The cumulative incidence of DM was 15.5% vs. 5.7% for luminal A, 10% vs. 8.7% for luminal B, 17.3% vs. 0% for HER2-enriched, and 6.8% vs. 7.1% for triple-negative in the mastectomy alone group compared to the postmastectomy IBR group. On multivariable Cox regression analysis, lymph node metastasis was associated with an increased risk of DM in the mastectomy alone group (p = 0.03) and neoadjuvant chemotherapy was associated with an increased risk of DM in the postmastectomy IBR group (p = 0.021).ConclusionThis study suggests that IBR does not have a negative impact on the LRR and DM of breast cancer according to molecular subtypes.

A national analysis of outpatient mastectomy and breast reconstruction trends from 2013 through 2019

Traditionally, patients with breast reconstruction (BR) were hospitalized at least one day postoperatively. However, new trends suggest that outpatient surgery is a viable and safe alternative. This study aims to assess trends among patients with breast cancer who underwent outpatient mastectomy alone, with immediate BR (IBR) or delayed BR (DBR). A retrospective analysis of the 2013-2019 ACS NSQIP® database was conducted. All women who underwent outpatient mastectomy were included in this study. The cohort was divided as follows: (1) mastectomy without BR, (2) IBR, and (3) DBR. A Cochran-Armitage test and adjusted multivariable logistic regression models were performed to evaluate linear trends over time within groups, and overall and pairwise comparisons between groups across the years, respectively. A total of 84,954 women were included in this study. Overall, 54.9%, 16.2%, and 28.9% underwent mastectomy without BR, IBR, and DBR, respectively. From the BR groups, the majority had implant placement. A significant difference in incidence trends between the three groups was evidenced over time (p<0.001). The greatest increase was evidenced in the IBR group and the lowest in the mastectomy without BR group. In this cohort of patients, a significant difference in linear trends was evidenced over time within and between the three groups. Our results suggest that outpatient IBR procedures are increasing in a greater proportion compared to other surgical approaches. Further studies are required to better characterize this population and comprehend the decision-making process toward a surgical procedure within each of the three groups.

Oncologic outcomes of immediate breast reconstruction in young women with breast cancer receiving neoadjuvant chemotherapy.

Oncologic safety of postmastectomy breast reconstruction in young women with breast cancer is not well-defined, especially in the setting of neoadjuvant chemotherapy (NACT). We retrospectively compared the oncologic outcomes following nipple-sparing (NSM)/skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) and conventional mastectomy (CM) alone in young breast cancer patients after NACT. A total of 1266 women with primary breast cancer who underwent NACT followed by total mastectomy with or without IBR were reviewed. Of these, only young patients (age ≤ 40years at diagnosis) were included in the outcome analysis (n = 375). After propensity score-matching by clinical T and N stage, molecular subtype, response to NACT, and adjuvant radiotherapy status, 228 patients were 1:1 matched, comprising balanced IBR group (with NSM/SSM) and CM-alone group. The 5-year locoregional recurrence-free, disease-free, distant metastasis (DM)-free, and breast cancer-specific survival (BCSS) rates for the entire cohort of young patients were 83.4%, 65.3%, 71.7%, and 85.4%, respectively. Locoregional recurrence rates between the matched groups were similar (14% vs. 15.8%; p = 0.710); however, IBR group had significantly lower DM rate (27.2% vs. 40.4%; p = 0.036) and breast cancer mortality (14.9% vs. 27.2%; p = 0.023) than CM-alone group. IBR group showed significantly improved 5-year DM-free survival (74.1% vs. 62.6%; p = 0.043) and BCSS (89.1% vs. 77.6%; p = 0.048) rates than CM-alone group. Our results indicated that IBR with NSM/SSM does not negatively affect long-term oncologic outcomes compared to CM alone in young women with breast cancer receiving NACT.

Is mastectomy with immediate reconstruction safe for patients undergoing neoadjuvant chemotherapy? A nationwide study from Korean Breast Cancer Society.

In this study, we compared the prognoses of patients who underwent mastectomy with immediate breast reconstruction (IBR) after neoadjuvant chemotherapy with those who underwent mastectomy. This retrospective study included 87,995 patients who were surgically treated for primary breast cancer between 2008 and 2014. We compared the three groups of patients who were divided based on the following surgeries: breast-conserving surgery (BCS), mastectomy, and mastectomy with IBR. Of the 3295 patients who were treated with neoadjuvant chemotherapy, 482 patients achieved a pathological complete response (pCR) and 2813 patients did not (non-pCR). In survival analysis of the pCR patients, the 5-year Overall Survival (5yr OS) between those who underwent mastectomy with IBR and mastectomy (P = 0.639) In the non-pCR group, 5yr OS of the mastectomy with IBR group was 90.0%, while those of the mastectomy group was 84.4% in patients with clinical stage II (P = 0.032). In a multivariate analysis by Cox regression method revealed that the prognoses of the patients who underwent mastectomy with IBR were not different from those of patients who underwent mastectomy group in both groups (the pCR group and the non-pCR group). In the pCR group, the prognoses of patients who underwent mastectomy with IBR were not different from those of patients who underwent mastectomy. In the non-pCR group, women in the mastectomy with IBR group had shown worse prognoses than the mastectomy group in advanced clinical stage. Appropriate operation should be determined depending on the status of individualized patients.

Long-term Oncologic Outcomes of Immediate Breast Reconstruction vs Conventional Mastectomy Alone for Breast Cancer in the Setting of Neoadjuvant Chemotherapy

An increasing number of patients with breast cancer receiving neoadjuvant chemotherapy (NACT) undergo immediate breast reconstruction (IBR) with nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) as surgical treatment. However, the oncologic efficacy and safety of this treatment sequencing strategy is unclear. To compare the long-term oncologic outcomes of IBR with NSM/SSM and conventional mastectomy (CM) alone for breast cancer in the NACT setting. A retrospective, propensity score-matched case-control study was conducted at Asan Medical Center, Seoul, Korea. A total of 1266 patients with breast cancer who underwent NACT followed by mastectomy with or without breast reconstruction between January 1, 2010, and November 30, 2016, were included. Data analysis was performed from July 1, 2019, to January 24, 2020. After propensity score matching, 323 patients who underwent IBR with NSM/SSM and 323 who underwent CM alone were selected for comparison of long-term oncologic outcomes. The 5-year local recurrence-free survival, disease-free survival, distant metastasis-free survival, and overall survival rates were calculated using the Kaplan-Meier method and compared using log-rank tests. Hazard ratios (HRs) and 95% CIs were estimated using the Cox proportional hazards regression model. After matching, the median follow-up periods were 67 (range, 17-125) months for the IBR group and 68 (range, 17-126) months for the CM-alone group. Median age of the women in the IBR group was 42 (range, 23-72) years; median age of those in the CM-alone group was 46 (range, 30-75) years. No significant differences were observed between the IBR and CM-alone groups in local recurrence (3.7% vs 3.4%; P = .83), regional recurrence (7.1% vs 5.3%; P = .33), or distant metastasis (17.3% vs 18.6%; P = .68) rates. There was also no significant difference between the IBR and CM-alone groups in 5-year local recurrence-free survival (95.6% vs 96.7%; HR, 1.124; 95% CI, 0.495-2.549; P = .78), disease-free survival (76.5% vs 79.9%; HR, 1.089; 95% CI, 0.790-1.500; P = .60), distant metastasis-free survival (82.5% vs 82.5%; HR, 0.941; 95% CI, 0.654-1.355; P = .74), or overall survival (92.0% vs 89.3%; HR, 0.847; 95% CI, 0.530-1.353; P = .49) rates. The long-term oncologic outcomes of IBR with NSM/SSM for breast cancer in this study appeared to be comparable to those of CM alone after NACT, suggesting the feasibility of IBR with NSM/SSM in the NACT setting.

Abstract P6-14-08: Impact of immediate breast reconstruction after mastectomy on the short and long-term outcome of patients receiving neoadjuvant chemotherapy

Abstract Background and Purpose In breast cancer patients receiving neoadjuvant chemotherapy (NAC), immediate breast reconstruction (IBR) is controversial. We retrospectively investigated whether IBR after mastectomy influenced the short and long-term outcome of patients receiving NAC. Patients and Methods Between April 2007 and December 2017, 525 breast cancer patients received NAC at our hospital of which 186 patients underwent total mastectomy alone, 55 underwent total mastectomy followed by IBR, and 284 underwent breast conserving surgery (BCS). Patients receiving IBR were compared to patients who did not receive IBR. The NAC regimen was 4 cycles of epirubicin, 5-fluorouracil and cyclophosphamide followed by 4 cycles of docetaxel. Decision making for post mastectomy radiotherapy (PMRT) followed national comprehensive cancer network guidelines. PMRT is not contraindication for patients receiving IBR, however risk such as capsular contracture was informed to patients. Tissue expander was replaced to silicon breast implant within two to three months, and radiotherapy started within 4 to 6 weeks after surgery. In other surgical-procedure, such as direct-to-implant breast reconstruction, BCS or mastectomy alone, radiotherapy started 6-8 weeks later. Post-mastectomy radiation was applied equally with the same selection criteria to both groups. Results Patients in the IBR and BCS groups were on average younger than patients in the mastectomy alone group (p&amp;lt;0.0001). In patients who underwent IBR, 29% of those with autograft and 47% of those with silicone breast implant were received radiotherapy. After a median of 76.4 month, 2 patients (4.2%) in the IBR group, 13 patients (4.5%) in the BCS group and 17 patients (9.1%) showed locoregional recurrences. Five-year locoregional recurrence-free survival was 96.1% in the IBR group, 96.8% in the BCS group and 90.1% in the mastectomy alone group (p= 0.032). Five-year distant disease-free survival was 92.9 % in the IBR group, 93.9% in the BCS group and 85.3 % in the mastectomy alone group (p= 0.0008). Five-year overall survival was 98.0 % in the IBR group, 98.4% in the BCS group and 92.3 % in the mastectomy alone group (p= 0.0004). Multivariate analysis showed that IBR was not associated with worse prognosis. Transverse rectus abdominis muscle flap necrosis was seen in one patient. Any breast implant or tissue expander related complications including infection and capsular contracture were not encountered. Conclusions IBR after total mastectomy can be performed safely and was not associated with worse prognosis in patients receiving NAC and therefore IBR may be the preferred strategy in select cases. Citation Format: Hiroko Nogi, Makiko Kamio, Takashi Kazama, Naoko Shimada, Takayuki Ishigaki, Hisashi Shioya, Yasuo Toriumi, Eijiro Nagasaki, Hiroshi Takeyama. Impact of immediate breast reconstruction after mastectomy on the short and long-term outcome of patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-08.

Abstract P4-13-06: Comparing immediate techniques of oncoplastic surgery (iTOP) with conventional breast conservation (CBC), the prospective controlled non-randomized iTOP trial (NCT01396993)

Abstract Introduction: Immediate techniques of oncoplastic surgery (iTOP) may be performed during breast conservation called oncoplastic breast conservation (OPBC) or skin/nipple sparing mastectomy defined as immediate breast reconstruction (IBR). There are no prospective data comparing both oncoplastic groups with women undergoing conventional breast conservation (CBC). Hypothesis iTOP are able to resect larger breast cancers with a similar quality of life comparing CBC Methods: Women with unilateral breast cancer stage I-III were eligible. Upon written and signed informed consent all relevant data including the two quality of life scales breast image scale (BIS) and Breast Q, were recorded at baseline as well as 6 and 12 months after surgery. Women were separated into three groups according to their standard treatment plan: • conventional breast conservation (CBC) • breast conservation with level I or II oncoplastic surgery (OPBC) • immediate breast reconstruction (IBR) with implants/autologous tissue. Results (statistics will be presented at the meeting): 206 women entered the trial (116 CBC, 46 OPBC, 44 IBR), 117 had a 6 month follow up and 99 were followed for 12 months. There were more pT2 and pT3 cancers (pT2: 15% and 14% versus 10%; pT3 7%, 7% and 2%; p at SABCS), more nodal positive cases (39%, 23% versus 12% p at SABCS) and more multifocal and multicentric cases (39%, 38% versus 20% p at SABCS) in the OPBC and IBR group compared with the CBC group. In 63% of cases the planned resection volume in OPBC was above 25% compared with 19% of cases in the CBC group. All groups had similar R1 resection rate (11%, 11% versus 9% p at SABCS) and no difference of the tumor distance to the resection margin. All groups were well balanced regarding neoadjuvant and adjuvant treatment. Only women with an IBR had an increased time to adjuvant radiotherapy compared with the other two groups (93 days versus 191 days median p at SABCS). Morbidity in OPBC was twice as high compared with IBR and CBC because of skin/wound necrosis and infections (total morbidity: 28% versus 16% and 12% p at SABCS). Quality of life using BIS, BREAST Q and VAS pain score did not differ between the three groups. Conclusion: Oncoplastic surgery resects larger tumors with similar quality of life in women with breast cancer stage I-III but with a higher morbidity rate. Oncologic recurrence data will be presented after a follow up of 5 years. CBCOPBCIBRn%n%n%1165746224421cT size1-2cm8271183916362-3cm201716358183-5cm109715818&amp;gt;5cm225111125FOCALITYunifocal938028612761multifocal1715817511multicentric6510221227PLANNED RESECTION VOLUME&amp;lt;25%9481173725&amp;gt;25%221929634295SEROMAyes10971512no1119644964398BLEEDINGyes223712no1119644964398NECROSISyes004949no11610042914091INFECTIONyes2261325no1149840874295VAS 6monthsmedian221percentile0-30-30-3.5VAS 12monthsmedian000.5percentile0-40-20.2BISat 12 months median (percentile)32-4.532-343-5.5 Citation Format: Michael Bolliger, Andreas Gleiss, Michael Schütz, Pia Lanmüller, Tanja Keusch, Bernhard Heilig, Werner Haslik, Daniela Dörfler, Lena Theresa Maghörndl, Florian Fitzal. Comparing immediate techniques of oncoplastic surgery (iTOP) with conventional breast conservation (CBC), the prospective controlled non-randomized iTOP trial (NCT01396993) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-13-06.

Immediate Breast Reconstruction vs. Mastectomy Alone in Locally Advanced Breast Cancer; Local Recurrence and Distant Recurrence

Purpose The oncologic safety of immediate breast reconstruction (IBR) has been demonstrated. However, the outcome of IBR for locally advanced breast cancer (LABC) is still under debate. We compared the survival outcome of LABC patients who underwent IBR vs. mastectomy alone. Methods We retrospectively analyzed a total of 248 patients with stage III breast cancer who were treated with mastectomy between 2004 and 2015. The study subjects were divided into 2 groups: patients who received IBR (n=77) or mastectomy alone (MA) (n=171). We compared disease-free survival (DFS) of both groups. Results Median follow-up duration was 49 months and the mean age of patients was 49 years. Patients in the IBR group were significantly younger and had lower body mass index (BMI) than those in the MA group. In a univariate analysis, IBR group showed better DFS than the MA group (DFS 81.3 months vs. 49.8 months, p<0.001). There was no delay in adjuvant treatment in the IBR group. In a multivariate analysis, IBR was associated with better DFS (hazard ratio (HR) for recurrence: 0.37, 95% CI 0.20–0.69, p=0.002) when adjusted for potential prognostic factors. In a subgroup analysis performed according to disease stage (IIIA and IIIB/IIIC), DFS was significantly better in IBR than MA group in both stage subgroups (p<0.001). Conclusion We demonstrated that patients who underwent IBR showed better DFS outcome compared with patients who underwent mastectomy alone. Our results can help surgeons to determine if IBR is an option in patients with LABC. Keywords: Breast neoplasms; Disease-free survival; Local neoplasm recurrence; Mammoplasty

Immediate versus delayed autologous breast reconstruction: A retrospective matched cohort study of irradiated patients

The impact of radiotherapy on breast reconstructions is not completely understood. The purpose of this study was to evaluate long-term effects of radiation therapy in relation to timing of autologous breast reconstruction. A total of 1247 patients undergoing autologous breast reconstruction at the University Hospitals of Leuven between August 1997 and October 2013 were subjected to a retrospective matched cohort study. Each patient who underwent immediate breast reconstruction (IBR) and received post mastectomy radiotherapy (PMRT) were matched with two patients receiving PMRT and delayed breast reconstruction (DBR), according to age and body mass index. Early and late complications were compared between both groups after a minimum follow-up of 3 years. The need for corrective procedures on the reconstructed and contralateral breast was also evaluated. Data were collected using patients' medical records. A total of 20 patients who underwent IR with PMRT were identified and matched to 40 patients who underwent DBR. There were two revisions in the DR group, both due to venous occlusion. Both revisions were successful and no flap failures occurred in either group. The rate of early complications did not differ significantly between the two groups. Among late complications were both the rates of fat necrosis (p<0.001) and skin contracture (p<0.001) higher in the IBR group than in the DBR group. Neither corrective procedures to the reconstructed breast nor symmetrizing operations in the contralateral breast, differed between the groups. The current study indicates that radiotherapy may contribute to adverse long-term flap-related outcome after IBR. We therefore recommend reconstructions to be delayed whenever possible in patients who will require PMRT.

Helical Tomotherapy (HT) for Postmastectomy Radiation Therapy (PMRT) Treatment after Implant Breast Reconstruction

To report our experience of using Helical Tomotherapy (HT) for postmastectomy radiation therapy (PMRT) treatment after immediate breast reconstruction (IBR) with implant. A total of 173 patients who underwent modified radical mastectomy for invasive breast cancer with or without IBR with retropectoral implants, received PMRT with HT at our institution between 2013 and 2015. PMRT with chest wall, supraclavicular and internal mammary lymph nodes irradiation was delivered to a dose of 50 Gy/25 fx. In the IBR group (n=87), the Planning Target Volume of chest wall (PTVcw) included subcutaneous tissue and pectoralis muscle plus margin, excluding the posterior side of the implant and the ribs, considering this volume as the main site of local recurrence of breast cancer. The treatment plans and outcomes were compared with those of 86 patients treated for PMRT by HT without IBR (control group). CW and Internal Mammary Nodes (IMN) coverage and doses to the organs at risk were compared between groups. Clinical outcomes were also assessed, including rate of reconstruction failure and prosthesis exchange. Coverage of chest wall was significantly improved in the IBR group in comparison with the group without reconstruction (V95% = 95.1 % versus 92.0 %; p<0.0001). There was no significant difference in the IMN coverage between the two groups (V95% = 93.1 % versus 92.4 %; p=0.3467). Irradiated volume of the ipsilateral lung was significantly decreased in the IBR group with a median V20Gy of 11.6 % compared with 15.2 % in the control group (p<0.0001). Similarly, the median V15Gy of the heart was significantly lower in the IBR group than in the control group (1.7 vs 2.5 %; p=0.0280). All neighboring organs received doses that remained well below tolerance levels. The treatment tolerance was acceptable without any definitive interruption and no grade 3 or 4 toxicity. The rate of reconstruction failure was 13,8% (n=12) and 33,3% of patient had implant replacement. After a median follow-up of 39.8 months, the locoregional recurrence rate was low in both groups (only 1 local and 3 regional relapses among the 87 patients in IBR group). Adequate and safe PMRT with Helical Tomotherapy can be offered to patients treated by mastectomy and IBR with retropectoral implants, with excellent dosimetric results and acceptable clinical outcomes.

Abstract P4-13-16: Impact of immediate breast reconstruction after mastectomy on the outcome of patients receiving neoadjuvant chemotherapy

Abstract Background and purpose In breast cancer patients receiving neoadjuvant chemotherapy (NAC), immediate breast reconstruction (IBR) is controversial. IBR might favor recurrences and metastases due to delayed adjuvant radiation therapy. We retrospectively investigated whether IBR after mastectomy influenced the outcome of patients receiving neoadjuvant chemotherapy. Patients and methods Between 2006 and 2016, 243 breast cancer patients received total mastectomy after NAC, 48 of whom underwent IBR. Patients receiving IBR (IBR group) were compared to patients who did not receive IBR (no-IBR group) over a prolonged median follow-up time (72.3 moths). The regimen was 4 cycles of epirubicin (100 or 75 mg/m2), 5-fluorouracil (500 mg/m2), and cyclophosphamide (500 mg/m2) followed by 4 cycles of docetaxel (75 mg/m2). Post-mastectomy radiation was applied in cases treated by IBR following the same selection criteria as for standard mastectomy regardless of the reconstruction approach. Results Patients in the IBR group were on average younger than patients in no-IBR group (p&amp;lt;0.001). The percentage of patients with clinical T1/2 tumor was 81.2% in the IBR group and 58.4% in no-IBR group (p=0.0042). 2 patients (4.2%) in the IBR group and 9 patients (4.6%) in no-IBR group showed the locoregional recurrences. 2 patients (4.2%) in the IBR group and 20 patients (10.3%) showed distant metastases. There were no significant differences. Conclusions IBR after total mastectomy was not associated with worse rate of locoregional recurrences in patients receiving NAC. Citation Format: Nogi H, Tomita S, Kamio M, Shioya H, Toriumi Y, Takeyama H. Impact of immediate breast reconstruction after mastectomy on the outcome of patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-16.

Quality of life after mastectomy with or without immediate breast reconstruction.

Mastectomy with immediate breast reconstruction (IBR) is a surgical strategy in breast cancer when breast-conserving surgery is not an option. There is a lack of evidence showing an advantage of mastectomy plus IBR over mastectomy alone on health-related quality of life (QoL). A large prospective multicentre survey, STIC-RMI (support of innovative and expensive techniques - immediate breast reconstruction), was undertaken to study the changes in QoL in patients treated by mastectomy with or without IBR. Patients were recruited between 2007 and 2009. European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 instruments were used to assess QoL before operation, and at 6 and 12 months after surgery. A propensity score was used to compare QoL between mastectomy alone and mastectomy plus IBR, with limited bias. A total of 595 patients were included from 22 French academic hospitals, of whom 407 (68·4 per cent) underwent IBR. One-year data were available for 71·1 per cent of patients. Factors associated with IBR were age, histological tumour type, palpable nodes and an attempt at breast-conserving surgery. At inclusion, QoL was significantly better in the IBR group (P < 0·001) and there was no significant change in either group during 1 year compared with baseline. Results for the QLQ-BR23 functional dimension varied according to propensity score quartiles; IBR had no influence in the lowest quartile. In the upper quartiles, QoL increased slightly over the year among patients who had IBR, whereas it decreased among those who had mastectomy alone (P = 0·037). Satisfaction with the cosmetic outcome strongly influenced QoL, especially in upper quartiles (P < 0·001). However, an unsatisfactory outcome after IBR was still considered a better condition than simple mastectomy. The QoL benefit provided by IBR depends on patients' life status at inclusion; young active women with an in situ tumour are more likely to preserve their QoL after IBR.

Abstract P3-14-12: Oncologic outcomes of immediate breast reconstruction after neoadjuvant chemotherapy in breast cancer patients: A matched case control study

Abstract Introduction: Although the indication for total mastectomy (TM) with immediate breast reconstruction (IBR) has been expanded, IBR after neoadjuvant chemotherapy (NACT) is still controversy. We assumed that TM with IBR after NACT is feasible surgical treatment in breast cancer patients. Methods: A retrospective review of breast cancer patients who underwent TM with IBR after NACT between 2008 and 2015 at a single center was conducted. These cases were matched by 1:5 to patients who underwent mastectomy alone after NACT. Matching variables included age, clinical T and N staging before NACT, response to NACT, and pathologic staging after NACT. Pathological stage was followed by seventh American Joint Committee on Cancer (AJCC) classification. Results: Overall, 31 patients were identified in the TM with IBR group (Study group) and 85 patients (Control group) were matched. In the study group, 13 (41.9%) patients underwent nipple-sparing mastectomy (NSM) and 18 (58.1%) underwent skin-sparing mastectomy (SSM). Median follow-up duration was 29.2 (7-31) and 38.8 (11-85) months for the study and control group, respectively. Median age was 37.0 (26-57) and 40.0 (24-56) years for the study and control group, respectively. The clinicopathologic characteristics of both groups are summarized in Table1. Disease-free survival (p=0.520), local recurrence-free survival (p=0.610), distant metastasis-free survival (p=0.795), and over survival (p=0.971) did not differ significantly between two groups. Conclusion: TM with IBR after NACT is feasible surgical treatment option in breast cancer patients. Clinicopathologic characteristicsVariablesControl group (n=85)Study group (n=31)p-valueAge, years (matching variables) 0.890≤3515 (17.7)9 (29.0) 36-5061 (71.8)21 (67.7) 51≥9 (10.6)1 (3.2) BMI, m2/kg 0.13025≤62 (72.9)28 (90.3) 26-3018 (21.2)2 (6.5) 30&amp;gt;5 (5.9)1 (3.2) Histology 0.326Ductal carcinoma in situ2 (2.4)3 (9.7) Invasive ductal carcinoma74 (87.1)28 (90.3) Invasive lobular carcinoma2 (2.4)0 (0) Others7 (8.2)0 (0) Multiplicity 0.063yes19 (22.6)12 (40.0) no65 (77.4)18 (60.0) Lymphovascular invasion 0.161yes33 (39.3)17 (54.8) no51 (60.7)14 (45.2) Nuclear grade 0.317Low10 (11.9)1 (3.3) Intermediate27 (32.1)14 (46.7) High47 (56.0)15 (24.2) Pathologic T stage (matching variable) 0.154T17 (8.2)6 (19.4) T229 (34.1)15 (48.4) T331 (36.5)4 (12.9) T418 (21.2)6 (19.4) Pathologic N stage (matching variable) 0.494N036 (42.4)13 (41.9) N123 (27.1)13 (41.9) N216 (18.8)4 (12.9) N310 (11.8)1 (3.2) Estrogen receptor 0.608positive49 (57.7)15 (48.4) negative36 (42.4)16 (51.6) Progesterone receptor 0.291positive40 (47.1)10 (32.3) negative45 (52.9)21 (67.7) HER2 status 0.345amplification29 (34.1)10 (32.3) not amplification56 (65.9)21 (67.7) Clinical T-stage (matching variable) 0.897cT12 (2.4)1 (3.2) cT231 (36.5)12 (38.7) cT346 (54.1)16 (51.6) cT46 (7.1)2 (6.5) Clinical N stage (matching variable) 0.947cN03 (3.5)1 (3.2) cN120 (23.5)10 (32.3) cN236 (42.4)10 (32.3) cN326 (30.6)10 (32.3) Response (matching variable) 1.000Partial response64 (75.3)27 (29.7) Stable disease21 (24.7)4 (12.9) Citation Format: Ryu JM, Lee JE, Kim SW, Yu J, Rayzah M, Lee SK, Mansoor A, Bae SY, Park S, Paik H-J, Kim I, Bang SI, Jeon BJ, Mun G-H, Pyon J-K. Oncologic outcomes of immediate breast reconstruction after neoadjuvant chemotherapy in breast cancer patients: A matched case control study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-12.

Impact of immediate breast reconstruction on the onset of adjuvant chemotherapy and on the postoperative complications

Objective: To explore the impact of immediate breast reconstruction on the onset of adjuvant chemotherapy and on the postoperative complications. Methods: We retrospectively analyzed the clinical data from female breast cancer patients treated by either modified radical mastectomy with immediate breast reconstruction(IBR) ( n=108) or modified radical mastectomy alone(n=115), followed by adjuvant chemotherapy at our department between January 2011 and December 2012. Results: There was no significant difference in the overall complication rates between the IBR group and modified radical mastectomy group (49.1% vs. 52.2%, P=0.87). However, more secondary surgery was applied in the IBR group than the modified radical mastectomy group (13.0% vs. 1.7%, P=0.001). However, the incidence of hematoma in the modified radical mastectomy group was significantly higher than the IBR group (17.4% vs. 4.6%, P=0.003). There was a significant difference in the onset of adjuvant chemotherapy between the IBR group and modified radical mastectomy group (21 days vs. 11days, P<0.001). Conclusions: Immediate breast reconstruction has no significant impact on the overall complication rate, but increases the incidence of secondary surgery, especially after the initiation of chemotherapy. In addition, it slightly delays adjuvant chemotherapy in the patients.