Lin Li1, Ying Chen1, Jiaying Chen1, Jiajian Chen1, Benlong Yang1, Junjie Li1, Xiaoyan Huang1, Zhenzhou Shen1, Zhimin Shao1, Peirong Yu2, Jiong Wu3. 1. Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. 2. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. Electronic address: wujiong1122@vip.sina.com.
Abstract
BACKGROUND: Fat necrosis is one of the most common complications following free flap breast reconstruction. Although a minor complication, fat necrosis can compromise esthetic results and confuse with cancer recurrence. Perfusion-related factors and post-operative radiotherapy are the known risks. However, the influence of adjuvant chemotherapy on fat necrosis prevalence remains unknown. METHODS: Our initial experience of 88 consecutive breast reconstructions with free abdominal flaps was reviewed. The prevalence of fat necrosis was recorded and the risk factors were analyzed using univariate and multivariate logistic regression models. RESULTS: The overall prevalence of fat necrosis was 36.4% in this series. In a multivariate logistic regression model, adjuvant chemotherapy significantly increased the risk of fat necrosis. The relative risk was 4.762 (95% confidence interval (CI), 1.767-12.831; p = 0.002). There was no evidence of a specific chemotherapeutic agent causing fat necrosis. The first cycle of adjuvant chemotherapy was frequently delivered earlier in patients with fat necrosis than those without fat necrosis, although this tendency was not statistically significant. CONCLUSIONS: Our initial experience with free flap breast reconstruction seems to suggest that chemotherapy may increase the risk of fat necrosis following immediate breast reconstruction. Patients should be fully informed, and the initiation of post-operative chemotherapy may be adjusted accordingly.
BACKGROUND:Fatnecrosis is one of the most common complications following free flap breast reconstruction. Although a minor complication, fatnecrosis can compromise esthetic results and confuse with cancer recurrence. Perfusion-related factors and post-operative radiotherapy are the known risks. However, the influence of adjuvant chemotherapy on fatnecrosis prevalence remains unknown. METHODS: Our initial experience of 88 consecutive breast reconstructions with free abdominal flaps was reviewed. The prevalence of fatnecrosis was recorded and the risk factors were analyzed using univariate and multivariate logistic regression models. RESULTS: The overall prevalence of fatnecrosis was 36.4% in this series. In a multivariate logistic regression model, adjuvant chemotherapy significantly increased the risk of fatnecrosis. The relative risk was 4.762 (95% confidence interval (CI), 1.767-12.831; p = 0.002). There was no evidence of a specific chemotherapeutic agent causing fatnecrosis. The first cycle of adjuvant chemotherapy was frequently delivered earlier in patients with fatnecrosis than those without fatnecrosis, although this tendency was not statistically significant. CONCLUSIONS: Our initial experience with free flap breast reconstruction seems to suggest that chemotherapy may increase the risk of fatnecrosis following immediate breast reconstruction. Patients should be fully informed, and the initiation of post-operative chemotherapy may be adjusted accordingly.