One-year surgical complications and cosmetic outcomes of neoadjuvant/adjuvant chemotherapy in reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant reconstruction

Background: The reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with direct-to-implant breast reconstruction (DIBR) is increasingly popular in China. It is critical to assess the impact of chemotherapy on postoperative outcomes. Study Design: A prospective cohort study was conducted between April 2020 and December 2023 at the Breast Center, XXX. Patients were followed for complications and cosmetic outcomes for at least 12 months post-surgery. Results: A total of 692 patients were enrolled: 241 (34.8%) received no chemotherapy (NC), 113 (16.3%) underwent neoadjuvant chemotherapy (NAC), and 338 (48.8%) received adjuvant chemotherapy (AC). Compared to the NC group, the AC group had higher rates of CDC≥2 complications (20.7% vs. 12.6%, 1.820 [1.144-2.895], P = 0.036) and SSI (18.0% vs. 8.8%, 2.240 [1.322-3.797], P = 0.003). Further analysis revealed that most complications occurred within 30 days (any, CDC ≥ 2, SSI, P < 0.05). Multivariable analysis showed a significant increase in any complications over time (OR, 1.680 [95% CI, 1.015-2.711], p = 0.044) and SSI after 30 days (OR, 2.346 [95% CI, 0.991-5.556], p = 0.052) in the AC group. After controlling for clinical covariates, no significant differences were observed among the NAC, NC, and AC groups in the BREAST-Q subscales and Ueda score. Conclusions: In R-E-NSM with DIBR, compared to AC, NAC was associated with a lower overall risk of postoperative complications. Neither NAC nor AC impaired patient- or physician-reported cosmetic outcomes. These results suggest NAC may be preferable for chemotherapy patients with implant reconstruction, but require validation in larger, longer-term studies.