What are My Options for Mastectomy after Neoadjuvant Chemotherapy?
- Current recommended options for mastectomy after neoadjuvant chemotherapy may include skin sparing mastectomy or nipple sparing mastectomy.
- When used in conjunction with neoadjuvant chemotherapy, immediate breast reconstruction may be as safe in regards to breast cancer survival as conventional mastectomy.
Wu ZY, Kim HJ, Lee JW, et al.
Long-term Oncologic Outcomes of Immediate Breast Reconstruction vs Conventional Mastectomy Alone for Breast Cancer in the Setting of Neoadjuvant Chemotherapy.
JAMA Surg. doi:10.1001/jamasurg.2020.4132
In recent years, women have been increasingly choosing mastectomy as a treatment option for their breast cancer due to advances in surgical options of women with the skin-sparing mastectomy and nipple-sparing mastectomy with immediate breast reconstruction. Skin sparing mastectomy involves removal of the breast tissue, glands, and nipple with preservation of the skin of the breast. A nipple sparing mastectomy removes the tissue underneath the nipple and the breast tissue but preserves the nipple, areola, and breast skin. Both the nipple- and skin-sparing mastectomy allow women to undergo immediate breast reconstruction in which implant or tissue-based reconstruction is placed at the time of the initial surgery. While immediate reconstruction has been previously shown to be a safe option for women with breast cancer, this had not been studied with the use of neoadjuvant chemotherapy. Neoadjuvant chemotherapy is the use of chemotherapy prior to surgical intervention. Previously, clinicians had been concerned about the use of neoadjuvant chemotherapy with immediate breast reconstruction due to issues with oncologic outcomes and wound healing.
The recent study cited here compared long-term oncologic outcomes of patients who underwent nipple- or skin-sparing mastectomy with immediate breast reconstruction versus conventional mastectomy in the setting of neoadjuvant chemotherapy. Their study evaluated patients from 2010-2016 out of Seoul, Korea who underwent neoadjuvant chemotherapy followed by any type of mastectomy. 1266 patients were identified for the study and divided into two groups based on whether they had immediate breast reconstruction (IBR) versus conventional mastectomy (CM). There was no difference in overall survival or disease-free survival after 5 years between the two cohorts. This lack of difference in recurrence and survival in IBR vs CM was still seen even in patients who originally had no response to neoadjuvant chemotherapy.
So what does this mean for our patients? Neoadjuvant chemotherapy is used for locally advanced or early stage breast cancer and suggested by the multi-disciplinary breast cancer team. When used in conjunction with neoadjuvant chemotherapy, immediate breast reconstruction may be as safe in regards to breast cancer survival as conventional mastectomy. It is best to discuss your breast cancer treatment and therapy options with your breast cancer team. Nipple- and skin-sparing mastectomy may be options based on the type and location of your cancer along with your body type. There are increasingly safe and effective options for the management of breast cancer that provide both good oncologic and cosmetic outcomes. Nipple and skin sparing mastectomy with immediate breast reconstruction is an option for many women with reliable efficacy for eligible women.