Implant-Based Breast Reconstruction: A Single-Center Retrospective Study

Implant-Based Breast Reconstruction: A Single-Center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Implant-Based Breast Reconstruction: A Single-Center Retrospective Study Chi Zhang, Hailin Yang, Zheng Zhou, Jihan Qiu, Hanzhi Li, Haochen Yu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8212590/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Currently, the use of neoadjuvant chemotherapy (NACT) and implant-based breast reconstruction (IBR) is becoming increasingly prevalent in clinical practice. This investigation sought to determine the impact of NACT on outcomes connected to IBR. Methods We analyzed the medical records of patients who underwent IBR at the First Affiliated Hospital of Chongqing Medical University during the period from January 1, 2008, to December 31, 2019.A total of 562 patients were enrolled, including 233 who received NACT and 329 who did not receive NACT. We evaluated complications and identified influencing factors. Patient satisfaction with reconstruction surgery was assessed using the BREAST-Q score. In the end, we assessed the patients' 5-year disease-free survival (DFS) rates. Results In baseline observations, we found statistically significant differences in age (P = 0.027), N stage (P = 0.037), histological grade (P = 0.001), Ki-67 expression (P = 0.011), and reconstruction mode (P = 0.002). There were also significant differences in the occurrence of seromas (P = 0.017) and skin-flap necrosis (P = 0.034) between the two groups of patients. T stage (P = 0.019) and diabetes (P = 0.001) were identified as independent influencing factors for total complications, while NACT was not. Between the non-NACT group and the NACT group, a significant difference in 5-year DFS was noted, with rates of 92.46% and 87.12%, respectively (P = 0.020). Conclusion Our research indicates that NACT is not an independent factor affecting common complications and does not influence patient satisfaction after IBR surgery. However, in clinical practice, individualized treatment plans should be formulated based on factors such as tumor size, age, diabetes history, and other relevant considerations to minimize the occurrence of complications. Breast cancer Neoadjuvant chemotherapy Implant-based Breast Reconstruction Complication Figures Figure 1 Figure 2 Figure 3 1. Introduction In 2020, breast cancer, which consists of various malignancies in the mammary glands, accounted for approximately 2.26 million cases, ranking as the primary cause of cancer-related deaths among females 1 . The global age-standardized incidence rate for females is approximately 48 per 100,000, varying from under 30 per 100,000 in sub-Saharan Africa to over 70 per 100,000 in Western Europe and North America 2 . It is noteworthy that mortality rates have been declining for over thirty years, with average survival rates of 86% at five years and 75% at ten years 3 . Breast cancer is predominantly composed of adenocarcinomas; specifically, about 85% originate from ductal epithelium while others arise from lobular epithelium 4 . According to histological characteristics, these can be grouped into four subtypes: Luminal A, Luminal B, HER-2 positive, and triple-negative (TNBC). This epidemiological trend and the classification of breast cancer types have both contributed to improvements in oncological treatments such as neoadjuvant chemotherapy and endocrine therapy as well as early management strategies for neoplasms related to breast cancer 5 , 6 . Neoadjuvant chemotherapy treatment (NACT) is a form of adjuvant therapy that administers chemotherapy prior to surgical intervention. This approach allows for early assessment of therapeutic response and may facilitate tumor downstaging. Consequently, this enhances the feasibility of tumor resection and increases surgical options available to patients—including mastectomy and breast-conserving surgery 7 . The rise in life expectancy and increased aesthetic awareness among women have led to a higher frequency of breast reconstructions following mastectomy. There is a notable trend towards immediate Implant-Based Reconstruction (IBR), which includes single-stage direct-to-implant (DTI) procedures as well as two-staged tissue expander/implant (TE/I) approaches 8 , 9 . Additionally, the surge in prophylactic mastectomies, driven by genetic susceptibility to breast cancer or a family history, has also resulted in more breast reconstruction operations 10 . However, NACT may have adverse effects on breast reconstruction outcomes, as chemotherapeutic agents target proliferating cells by inducing apoptosis, necrosis, and death of cancerous tissue 11 , 12 . Chemotherapy not only undermines wound strength and healing through detrimental impacts on cell division and metabolism, angiogenesis, and protein synthesis but can also lead to transient aplastic anemia. This condition hampers normal inflammatory responses to trauma, thereby increasing the risks of wound infections, flap necrosis, and other complications 13 – 15 . Despite these concerns, the influence of NACT on surgical complication rates following prosthetic reconstruction remains underexplored—particularly regarding patients’ satisfaction among those who underwent NACT with their prosthesis. As a result, we examined breast reconstruction records at our facility to compare the rates of complications, BREAST-Q scores, and three-year survival outcomes between patients undergoing prosthetic reconstruction after NACT and a control group that received skin-sparing mastectomy followed by prosthetic reconstruction without NACT. Our aim was to determine whether NACT significantly impacts IBR, thereby providing insights for clinical practice. 2. Materials and Methods 2.1 Patients The clinical databases of the First Affiliated Hospital of Chongqing Medical University were used to obtain medical records of breast cancer patients treated from January 1, 2008, to December 31, 2019. Approval for this retrospective study was granted by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (Reference No. 2020 − 202). All processes were carried out following the applicable guidelines. Criteria for inclusion: (I) Female; (II) Invasive breast cancer confirmed by pathological examination; (III) Received IBR (DTI/TE/I) with or without neoadjuvant chemotherapy; (IV) No prior anti-tumor treatment. Exclusion criteria: (I) Metastasis at diagnosis; (II) Presence of other primary tumors; (III) Bilateral breast cancer; (IV) Incomplete data; and (V) Incomplete neoadjuvant chemotherapy period. In conclusion, 618 patients who met the eligibility requirements were included in this study (Fig. 1 ). All tissue samples were embedded in paraffin and examined by two seasoned pathologists. This article does not address patient privacy; therefore, informed consent was deemed unnecessary. All data were fully anonymized prior to our access. The authors were not provided with any personally identifiable data at any stage of the data collection. 2.2 Clinicopathological analysis In total, 622 eligible patients were ultimately included for further analysis. This cohort comprised 233 patients who received IBR following NACT as well as patients who received IBR without prior NACT. To comprehensively analyze the efficacy and satisfaction of IBR, we collected general information including age, body mass index (BMI), history of diabetes, menstrual status, and NACT regimens. Additionally, clinicopathological data were gathered encompassing tumor stage (stage_T and stage_N), estrogen receptor (ER) status, progesterone receptor (PgR) status, HER2 status, Ki67 index, and P53 status. Clinical assessments related to breast cancer, including lymph node involvement (stage_N) and tumor size (stage_T), were determined through magnetic resonance imaging (MRI) or breast ultrasonography. The evaluation of ER, PgR, HER2 expression levels, Ki67 index, and P53 status was conducted using immunohistochemistry (IHC) on samples obtained via core needle biopsy. HER2 negative status was defined by an IHC score of 0 or 1+, or a score of 2 + with non-amplified fluorescence in situ hybridization (FISH) 16 . Conversely, HER2 positive status was characterized by high levels of HER2 expression indicated by an IHC score of 3+, or a score of 2 + with amplified FISH results. Samples exhibiting more than 1% positivity for ER/PgR expression were classified as ER-positive/PgR-positive. The Ki67 index was calculated as the percentage of tumor cells displaying nuclear staining across at least ten high-powered fields at ×40 magnification from a minimum total count of 1000 tumor cells 17 . 2.3 Treatment Breast cancer patients were considered for NACT if they presented with advanced-stage disease, including involvement of axillary lymph nodes, sizable tumors, or infiltration of the skin or chest wall 18 . NACT was administered based on local protocols and relevant international guidelines in effect at the time. The treatments primarily consisted of anthracycline and taxane-based regimens. The TEC regimen (docetaxel 75 mg/m², epirubicin 75 mg/m², and cyclophosphamide 500 mg/m²) or EC regimen (epirubicin 75 mg/m² and cyclophosphamide 500 mg/m²) was administered every three weeks. For HER2 positive patients, trastuzumab-based chemotherapy (8 mg/kg for the first dose; 6 mg/kg for subsequent doses) was given every three weeks for a total of six cycles prior to surgery. Surgery was performed two weeks after completion of the full treatment regimen 19 . All participants in our study underwent surgery following standardized procedures consistent with the guidelines set forth by CSCO and NCCN 19 . Mastectomy involved resection of the areolar complex, ensuring optimal removal of all mammary glandular tissue. Patients in the NACT group (n = 233), who had confirmed pathological evidence of metastatic axillary lymph nodes prior to NACT, received axillary lymph node dissection (ALND). Conversely, other participants in either the NACT group or control group were required to complete sentinel lymph node biopsy (SLNB) to determine eligibility for ALND. Following skin-sparing mastectomy, a subpectoral cavity was created to facilitate implantation of either a permanent endoprosthesis or a temporary tissue expander. Patients undergoing ALND had temporary tissue expanders placed during post-mastectomy radiotherapy (PMRT), which were subsequently replaced by prosthesis upon completion of PMRT. In contrast, other patients received immediate breast reconstruction using prosthesis. 2.4 Complications All major complications that occurred one year after surgery were recorded for each reconstructed breast as primary endpoints. Major complications were characterized by the occurrence of any of the following events: (I) implant/expander loss (I/E); (II) skin flap necrosis; and (III) distant recurrence 20 . Minor complications were considered present if any of the following occurred: (I) wound breakdown; (II) hematoma; (III) seroma; (IV) fat necrosis; and (V) infection 21 . Implant loss was defined as the removal of a prosthesis without any immediate replacement. Skin flap necrosis was characterized by a loss of elasticity in the flap, accompanied by blackening and pain due to ischemia. Hematoma denoted an intramammary blood collection that warranted operative management. A seroma referred to tissue fluid accumulation beneath the skin necessitating aspiration. Infection was identified by localized or systemic evidence that required antibiotic administration. Distant recurrence was defined as confirmed evidence of neoplasm occurring in organs other than the breast in patients who had no metastasis prior to surgery but developed it post-reconstruction. We meticulously examined all collected complications along with the time interval between surgery and reconstruction for each patient for subsequent analysis. 2.5 Objective The secondary outcome measured was the change in quality of life (QoL) at 12 months. The BREAST-Q (v2.0), which evaluates QoL, covers various aspects including satisfaction with breast appearance and outcomes, sexual well-being, physical well-being of the chest, and psychosocial well-being 22 . Participants completed the questionnaire at reconstruction surgery, as well as six and twelve months afterward. After the reconstruction procedure, we attempted to contact each patient using the information provided at their initial admission to our hospital. Detailed records regarding their health conditions and life status were maintained. In cases where patients could not be reached, we opted to contact their designated guardians, who served as points of reference during the patients' medical treatment in our facility. Patients or guardians who could not be contacted were excluded from further consideration. The 5-year disease-free survival rate was calculated next, considering DFS as the duration from surgery to any relapse, secondary malignancy, or all-cause mortality. 2.6 Statistical methods Data analysis was carried out using SPSS (Version 25.0). The chi-squared test or Fisher’s exact test was applied to categorical variables, while continuous variables were evaluated with the t-test. The Kaplan-Meier method was employed to estimate follow-up data, while univariate and multivariate regression analyses identified factors associated with complications. A P-value < 0.05 was deemed significant. 3. Results 3.1 Baseline clinicopathological characteristics of patients between the two groups The basic characteristics of the patients are summarized in Table 1 . From 2008 to 2019, 233 patients underwent NACT followed by prosthesis breast reconstruction, while 329 patients received prosthesis breast reconstruction without NACT. A median follow-up of 84 months was recorded, during which significant differences emerged between the groups regarding age, N stage, histological grade, Ki-67 index, and clinical stage. Notably, patients undergoing NACT were generally younger (P = 0.027), exhibited higher histological grades (P = 0.001), advanced T_stage (P < 0.001) and showed more advanced axillary lymph node involvement (P < 0.001). Additionally, The Ki-67 index was also markedly greater in patients receiving NACT versus those who did not (P = 0.011). Moreover, patients in the NACT group were more likely to undergo two-staged tissue expander/implant (TE/I) procedures (P = 0.002). Table 1 Baseline clinicopathological characteristics of patients undergoing breast reconstruction surgery. Characteristic Total (n = 562) Non-NACT (n = 329) NACT (n = 233) P value a Age (years) 0.027 <45 391(69.6%) 217(66.0%) 174(74.7%) ≥ 45 171(30.4%) 112(34.0%) 59(25.3%) BMI 0.889 <24 443(78.8%) 260(79.0%) 183(78.5%) ≥ 24 119(21.2%) 69(21.0%) 50(21.5%) Diabetes 0.817 Without 507(90.2%) 296(90.0%) 211(90.6%) With 55(9.8%) 33(10.0%) 22(9.4%) Menopausal status 0.765 Premenopausal 397(70.6%) 234(71.1%) 163(70.0%) Postmenopausal 165(29.4%) 95(28.9%) 70(30.0%) Tumor location 0.458 Left 279(49.6%) 159(48.3%) 120(51.5%) Right 283(50.4%) 170(51.7%) 113(48.5%) T stage <0.001 Ⅰ 292(52.0%) 234(71.1%) 58(24.9%) Ⅱ 248(44.1%) 93(28.3%) 155(66.5%) Ⅲ/Ⅳ 22(3.9%) 2(0.6%) 20(8.6%) N stage <0.001 0 421(74.9%) 287(87.2%) 134(57.5%) 1 102(18.1%) 41(12.5%) 61(26.2%) 2–3 39(6.9%) 1(0.3%) 38(16.3%) Histological grade 0.001 Grade 1 10(1.8%) 8(2.4%) 2(0.9%) Grade 2 484(86.1%) 295(89.7%) 189(81.1%) Grade 3 68(12.1%) 26(7.9%) 42(18.0%) ER status 0.997 Negative 152(27.0%) 89(27.1%) 63(27.0%) Positive 410(73.0%) 240(72.9%) 170(73.0%) PgR status 0.144 Negative 214(38.1%) 117(35.6%) 97(41.6%) Positive 348(61.9%) 212(64.4%) 136(58.4%) HER2 status 0.751 Negative 445(79.2%) 259(78.7%) 186(79.8%) Positive 117(20.8%) 70(21.3%) 47(20.2%) P53 status 0.098 Negative 283(50.4%) 156(47.4%) 127(54.5%) Positive 279(49.6%) 173(52.6%) 106(45.5%) Ki-67(%) 0.011 ≤ 20 247(44.0%) 162(49.2%) 85(36.5%) (20, 50] 251(44.7%) 134(40.7%) 117(50.2%) >50 64(11.4%) 33(10.0%) 31(13.3%) Reconstruction mode 0.002 Ⅰ 401(71.4%) 218(66.3%) 183(78.5%) Ⅱ 161(28.6%) 111(33.7%) 50(21.5%) Complications 0.730 Suffered 78(13.9%) 46(14.0%) 35(15.0%) None 484(86.1%) 283(86.0%) 198(85.0%) Reccurence 0.038 Suffered 55(9.8%) 25(7.6%) 30(12.9%) None 507(90.2%) 304(92.4%) 203(87.1%) BMI Body Mass Index, ER estrogen receptor, PgR progesterone receptor, NACT neoadjuvant chemotherapy a P values were determined by chi-square tests. Bold values indicate statistical significance ( P < 0.05) 3.2 Complications and influencing factors At the outset, the incidence of total complications was comparable between the non-NACT and NACT groups (Table 2 ). In univariate analysis, age (P = 0.016), diabetes (P < 0.001), and T stage (P = 0.027) were identified as factors associated with total complications. Consequently, these variables were incorporated into the subsequent multivariate analysis. The findings revealed that diabetes (P = 0.001) and T stage (P = 0.019) independently predicted total complications (Table 3 ). Table 2 Detail data showing the complications. Patients Total complications Hematomas Seromas Infection Implant loss Fat necrosis Wound breakdown Skin-flap necrosis Surgical re-intervention Non-NACT 329 46/329 (13.98%) 12/329 (3.65%) 7/329 (2.13%) 27/329 (8.21%) 31/329 (9.42%) 3/329 (0.91%) 10/329 (3.04%) 12/329 (3.36%) 45/329 (13.68%) NACT 233 35/233 (15.02%) 16/233 (6.87%) 14/233 (6.01%) 24/233 (10.30%) 24/233 (10.30%) 8/233 (3.43%) 6/233 (2.58%) 17/233 (7.32%) 32/233 (13.73%) P value 0.730 0.084 0.017 0.395 0.730 0.069 0.744 0.034 0.985 Table 3 Univariate and multivariate analyses of total complications and clinicopathological characteristics. Characteristics Univariate analysis HR (95% CI) P value Multivariate analysis HR (95% CI) P value HR 5% CI 95% CI HR 5% CI 95% CI Age, years (≥ 45 vs < 45) 1.816 1.12 2.946 0.016 1.478 0.874 2.5 0.145 BMI (≥ 24 vs < 24) 1.265 0.729 2.196 0.403 Diabetes (With vs Without) 3.429 1.841 6.386 <0.001 2.967 1.527 5.766 0.001 Menopausal status (Postmenopausal vs Premenopausal) 0.663 0.405 1.086 0.103 Tumor location (Left vs Right) 1.012 0.632 1.621 0.959 T stage cT1 cT2 1.001 0.612 1.637 0.997 1.03 0.623 1.704 0.907 cT3/cT4 2.94 1.129 7.657 0.027 3.24 1.211 8.671 0.019 N stage (Nx vs N0) 0.975 0.565 1.683 0.929 Therapeutic strategies (NACT vs non-NACT) 1.088 0.676 1.75 0.730 Reconstruction mode (IBR vs two-staged) 0.986 0.585 1.661 0.957 Histological grade (Ⅲ vs Ⅰ/Ⅱ) 1.169 0.584 2.338 0.659 ER status (Positive vs Negative) 0.751 0.451 1.249 0.270 PgR status (Positive vs Negative) 0.734 0.456 1.182 0.203 HER2 status (Positive vs Negative) 1.515 0.884 2.596 0.131 P53 status (wild vs Mutant) 0.784 0.488 1.258 0.312 Ki-67 (>50% vs ≤ 50%) 1.013 0.709 1.448 0.980 3.2.1 Major complications Among 233 patients who received NACT before IBR, implant loss occurred in 10.3% (N = 24/233) of patients, compared to 9.4% (N = 27/329) in the non-NACT group (P = 0.730). The incidence of skin-flap necrosis was significantly higher among patients receiving NACT with a rate of 7.32% (N = 17/233) compared to 3.36% (N = 12/329) in the non-NACT group ( P = 0.034). Additionally, there was no statistically significant difference in the need for surgical intervention between the two groups, with rates of 13.73% (N = 32/233) and 13.68% (N = 45/329), respectively (P = 0.985). Both univariate and multivariate analyses demonstrated that T stage (P = 0.017) independently influenced implant loss, while diabetes (P = 0.047) and T stage (P = 0.001) were independently associated with skin-flap necrosis. Multivariate analysis also indicated that diabetes (P = 0.002) was a significant factor influencing the need for surgical intervention ( Supplement Table 1 ). 3.2.2 Minor complications Receipt of NACT was significantly linked to a higher risk of seroma formation (P = 0.017). The analysis revealed no statistically meaningful variation in rates of fat necrosis (P = 0.069), infections (P = 0.395), wound breakdown (P = 0.744), or hematoma (P = 0.084) between the two groups. Seroma formation was independently influenced by tumor location and T stage, as shown by univariate and multivariate analyses (P = 0.042 and P = 0.004, respectively). Additionally, T stage (P = 0.009) was independently associated with hematoma. For infections, diabetes (P = 0.024) was identified as an independent factor. Furthermore, age (P = 0.008) and T stage (P < 0.001) were found to be independent factors for wound breakdown ( Supplement Table 1 ). 3.3 Evaluation of patients' satisfaction with breast reconstruction Table 4 presents the outcomes of different BREAST-Q domains, stratified by treatment group. Total scores did not differ between the NACT and non-NACT groups (P = 0.991). More precisely, the groups did not differ significantly in three domains: satisfaction with breast (P = 0.599), sexual well-being (P = 0.990), and psychological well-being (P = 0.616). Notably, patients in the NACT group reported better chest physical well-being than those in the non-NACT group, a difference that reached statistical significance (P = 0.005; Fig. 2 ). 3.4 Survival analysis of patients In our cohorts, the median follow-up time was 86 months for the non-NACT group and 83 months for the NACT group. Notably, 12.9% (N = 30/233) of patients who received NACT experienced recurrence within 5 years after breast reconstruction, which was significantly higher than the 7.6% (N = 25/329) recurrence rate in the control group (P = 0.038). The non-NACT group showed a superior DFS rate of 92.4% (304 of 329 patients) versus 87.1% (203 of 233 patients) in the NACT group, a statistically significant difference (P = 0.020; Fig. 3). 4. Discussion Despite its growing role in making surgery feasible for advanced breast cancer patients, the effects of NACT on perioperative and long-term outcomes remain uncertain—especially in the context of breast reconstruct 23 , 24 . Chemotherapy's mechanism of targeting proliferating cells and interfering with their specific processes suppresses the immune system, thereby impairing wound healing and increasing infection susceptibility. Experimental findings consistently indicate a reduction in wound tensile strength following chemotherapy treatment 25 , 26 . The impact of agents such as anthracyclines on endothelial cells is well established, with potential consequences including an elevated risk of thrombosis and subsequent major or minor complications 27 . Despite their significance, these effects remain underexplored in clinical settings, necessitating further investigation into the influence of NACT on patients receiving IBR 28 . One notable finding indicated that the odds of undergoing immediate breast reconstruction are significantly reduced in women treated with NACT, even after adjusting for factors such as age, disease stage, and postoperative 29 . This difference may be attributed to surgeons' concerns about potential complications, leading to fewer IBR in clinical practice. Conversely, Jajini Varghese et al. assessed 3,249 patients who underwent immediate breast reconstruction and reported no significant increase in postoperative complication risk associated with NACT (RR 0.91, 95% CI 0.74–1.11, p = 0.34) 30 . In a comparable finding, a recent meta-analysis concluded that NACT had no significant impact on the incidence of major or minor complications after IBR, whether performed with autologous tissue or implants 31 . Notably, the patient cohorts in these studies comprised individuals undergoing TE/I or autologous flap reconstruction, irrespective of whether they received post-mastectomy radiation therapy (PMRT). In light of the uncertainty surrounding the impact of NACT on IBR outcomes, a number of studies have been undertaken to further investigate the issue. In this study, we set out to access the impact of the NACT on IBR to better indicate clinical use of breast reconstruction surgical patterns. Findings from this study suggest that preoperative NACT does not influence the overall incidence of complications following IBR, as no statistically significant differences were observed in major or minor complication rates between the two patient groups. This finding aligns with the results of a retrospective review conducted by Mehrara et al., which reached a similar conclusion 32 . Similarly, a meta-analysis by Jajini Varghese et al. found minimal evidence of a difference in overall complication rates between women treated with NACT and those who were not 30 . Conversely, Dolen et al. analyzed 889 patients with TE/I, of whom 295 received NACT, and found significantly higher complication rates among NACT patients compared to those who did not receive NACT 33 . Our analysis revealed statistically significant differences in the incidence of certain complications between the NACT and non-NACT cohorts; however, multivariate analysis demonstrated that NACT was not an independent predictor of these outcomes. The minor complications observed in this study included seroma, hematoma, wound breakdown, and fat necrosis. The administration of NACT may compromise blood supply to the surgical area, inhibit cellular recovery, and impair wound healing 34 . Consequently, the selection of reconstruction methods for these patients should be approached with greater caution. Apart from seroma, no significant differences were noted in other complications between the two groups. Conversely, a meta-analysis reported that none of the included studies demonstrated a significant association between NACT and the incidence of seroma 30 . Notably, Beugel et al. reported lower rates of minor complications among women who received NACT prior to surgery, which contradicts theoretical expectations. The authors attributed this observation to the younger age of patients in the NACT group and the higher prevalence of active smokers in the control group 35 . Univariate analysis identified T stage (P = 0.002), NACT (P = 0.022), tumor location (P = 0.049), menopausal status (P = 0.023), and diabetes (P = 0.036) as potential risk factors. However, multivariate analysis indicated that NACT does not serve as an independent risk factor for seroma formation; rather, tumor location and T stage are significant predictors. Given that the right arm is the preferred side for most people, attention should be paid to the tension of the skin flap for larger masses, and movement of the affected limb should be minimized in the short-term following surgery. Besides, chemotherapy can induce coagulation disorders, potentially contributing to seroma formation 27 , 36 . Furthermore, premature extubation leading to the early removal of drains may result in fluid accumulation and subsequently seroma formation. Therefore, surgeons are advised to regularly assess drainage output and remove drainage tubes appropriately after surgery 37 . With respect to wound breakdown, our study demonstrated no significant difference in the incidence between patients who received NACT prior to mastectomy and IBR and those who did not. Consistently, Decker et al. reported a trend toward a modest increase in wound complications among patients who received NACT prior to mastectomy and IBR; however, this association did not reach statistical significance (OR = 1.58; 95% CI: 0.98–2.58) 21 . Similarly, a meta-analysis by Jajini Varghese et al. indicated that NACT administration was not associated with a significantly higher risk of wound breakdown 30 . Conversely, Az-Zawi et al. documented an elevated rate of wound-related complications among patients undergoing NACT (10%) relative to those who did not receive NACT (6%) 38 . As we assumed, the regular use of antibiotics during and after surgery may help reduce infection rates, thereby preventing wound breakdown 39 . Additionally, the surgeons at our center have undergone professional training in suturing techniques, which ensures effective wound healing and may contribute to the lower incidence of wound breakdown observed in our center. According to multivariate analysis, age (P = 0.008) and T stage (P < 0.001) appear to be significant factors influencing wound breakdown, potentially explaining the findings from Az-zawi et al. Furthermore, chemotherapeutic agents have been implicated in the disruption of extracellular matrix remodeling by impairing collagen production, thereby prolonging the wound healing process and heightening the risk of wound dehiscence 26 . Accordingly, the effects of neoadjuvant chemotherapy on postoperative wound integrity necessitate further comprehensive assessment. Regarding other minor complications, this study did not find a statistically significant association between NACT and hematoma (P = 0.084), infection (P = 0.395), or fat necrosis (P = 0.069). Although lower rates of minor complications were observed among patients without NACT, these differences were not statistically significant. Song et al. reported that administration of neoadjuvant chemotherapy did not significantly influence the incidence of minor postoperative complications, including hematoma, implant-related infections, partial flap necrosis, or complete flap failure 9 . In a similar vein, Shayoni Nag et al. observed no statistically significant variation in the occurrence of minor complications between patients treated with neoadjuvant chemotherapy and those who were not 40 . The meta-analysis by Jajini Varghese et al. further confirmed that the frequency of hematoma was comparable between patients who received NACT and those who did not, with a risk ratio of 0.99 (95% confidence interval: 0.61 to 1.60; p = 0.97) 30 . Conversely, a retrospective review indicated that patients treated with NACT prior to IBR had a significantly higher incidence of fat necrosis 32 . Therefore, larger clinical trials may be necessary to further evaluate the impact of NACT on minor complications. In our study, major complications following immediate breast reconstruction encompassed implant loss, skin flap necrosis, and the requirement for additional surgical intervention. Several factors may contribute to the occurrence of these major complications. Firstly, minor complications are clinically significant in immediate breast reconstruction, as delayed wound healing, infection, and dehiscence can predispose patients to implant loss and additional adverse outcomes 41 . Moreover, numerous complications—particularly those related to wound healing—are challenging to accurately assess in retrospective studies, potentially leading to underestimation of their true incidence 30 . Secondly, inappropriate sizing of the prosthesis, excessive tension, and incorrect suture selection can also contribute to implant loss. Lastly, inadequate assessment of patients' underlying conditions, such as diabetes, obesity, and smoking, can increase the risk of major complications 42 . The outcomes of our investigation demonstrate that the frequency of significant postoperative complications does not differ substantially between patients administered neoadjuvant chemotherapy and those who did not receive such treatment. However, our findings indicate that patients who received NACT are more likely to develop skin-flap necrosis (P = 0.034). Corroborating this, Lorentzen et al.’s meta-analysis identified a heightened risk of skin flap necrosis in patients receiving immediate breast reconstruction subsequent to neoadjuvant chemotherapy 34 . Conversely, the study by Ajla Sabitovic et al. revealed no significant relationship between the administration of neoadjuvant chemotherapy and the development of skin flap necrosis 30 . Notably, Allué Cabañuz et al. reported a decreased occurrence of skin flap necrosis in the cohort of patients who received neoadjuvant chemotherapy 43 . Our multivariate analysis demonstrated that both diabetes mellitus and clinical T classification serve as independent risk factors for the development of skin flap necrosis (P = 0.047 and P < 0.001, respectively). Excessive tumor volume may lead to excessive flap detachment, while metabolic disorders caused by diabetes can affect skin growth and repair 44 . It still requires further evaluation. As for implant-loss, the current study found that the incidence of it was comparable between the two groups. Similarly, Song et al. found no evidence that neoadjuvant chemotherapy elevated the risk of implant loss in women undergoing immediate breast reconstruction 9 . In line with this, Peled et al. also reported no significant association between implant loss and the administration of neoadjuvant chemotherapy 45 . Interestingly, a significantly higher proportion of patients in the NACT group received PMRT after surgery in this study. Despite this disparity, the incidence of implant loss did not appear to increase among those who received neoadjuvant chemotherapy. In contrast, Jiménez-Puente et al. reported a substantially higher rate of expander/implant (E/I) loss in the NACT group (7 of 13 cases) compared to the non-NACT group (19 of 102 cases), corresponding to an odds ratio of 5.10 (P = 0.004) 46 . Furthermore, the pooled results from a meta-analysis conducted by J. Varghese et al., which evaluated data from five studies, indicated that implant loss was more likely to occur in patients receiving NACT. However, these results may be influenced by other adjuvant therapies such as PMRT 30 . In our study, primary tumor size emerged as the main influencing factor for implant loss. It is hypothesized that the huge size of the tumors may be apt to influence the elasticity and blood supply of the skin around them further attributing to the implant loss. Finally, our analysis revealed no statistically significant elevation in the frequency of secondary surgical procedures among patients who received neoadjuvant chemotherapy. This conclusion is consistent with findings from two meta-analyses conducted by Ajla Sabitovic et al. and Song et al 9, 31 . A possible explanation for the comparable rates of surgical intervention may be the regular long-term follow-up, which provides surgeons with detailed postoperative information, allowing them to address patient issues promptly. Major complications are often the result of minor complications. Therefore, proper use of antibiotics, minimizing flap tension, and maintaining blood glucose control are crucial for reducing the incidence of minor complications. This study identified no significant variation in BREAST-Q outcomes across most domains, with the sole exception of the Chest Physical Well-being subscale, which demonstrated a statistically meaningful difference. Patients who did not receive NACT had significantly higher scores in this domain compared to those who received NACT. A plausible explanation is that the NACT cohort primarily comprised individuals with more advanced-stage breast cancer, for whom adjuvant radiotherapy was more frequently indicated. The side effects of radiotherapy, such as peeling, swelling, and ulceration, may negatively impact patient satisfaction. Additionally, the difference in this domain may be attributed to reduced breast sensation and/or potential recurrence 47 . Furthermore, we observed a statistically significant higher 5-year recurrence-free survival (RFS) rate in the NACT group compared to patients who did not receive NACT. Nonetheless, a Bayesian evaluation by Shen et al. demonstrated favorable overall survival (OS) outcomes in individuals undergoing neoadjuvant chemotherapy followed by mastectomy and immediate breast reconstruction, despite the presence of selection bias—specifically, the control group comprised significantly younger patients 48 . In our analysis, the more advanced clinical staging observed in the NACT cohort may partially account for the less favorable outcomes documented in this group. Meanwhile, the side effects of chemotherapy agents may also contribute to the significantly shorter RFS in the NACT group 11 , 12 . In the present study, certain limitations should be acknowledged. First of all, this study was conducted in Chinese individuals, so conclusions cannot be simply applied to populations with different racial backgrounds. Although the dataset was sufficiently robust to enhance the reliability of our findings, the single-center design and retrospective methodology may have introduced both selection and information biases. Conclusion In summary, while our study identified differences in certain complications between the two groups, NACT is not an independent influencing factor. To mitigate patient discomfort and prevent potential complications, surgeons should prudently use antibiotics and consider factors such as age, BMI, and underlying health conditions like diabetes when developing appropriate treatment plans. Declarations Data availability Statement The clinicopathological data underpinning the findings of this study are accessible in the Figshare repository: https://doi.org/10.6084/m9.figshare.28090466. Ethical Approval All procedures were conducted in accordance with applicable institutional and national guidelines. Ethical approval for this study was granted by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (Approval No. 2020-202). Informed Consent Informed consent was waived due to the retrospective design of the study. All patient data were handled with strict confidentiality, and all procedures were conducted in accordance with the requirements of the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. Acknowledgments The authors express their sincere gratitude to all study participants, research personnel, and students whose contributions were essential to the completion of this work. Author Contributions Conceptualization, Lingfeng Tang and Shengchun Liu; Data curation, Chi Zhang, Hailin Yang, Zheng Zou; Formal analysis, Chi Zhang, Hailin Yang, Zheng Zou; Investigation, Lingfeng Tang, JiHan Qiu ; Methodology, Lingfeng Tang, Haochen Yu and Shengchun Liu; Resources, Lingfeng Tang, Hailin Yang and Zheng Zou; Software, Hanzhi Li and Haochen Yu; Supervision, Lingfeng Tang and Shengchun Liu; Writing-original draft, Lingfeng Tang, Chi Zhang and Hailin Yang; Writing-review & editing, Lingfeng Tang and Zheng Zou. Funding Statement This work was supported by the Key Research and Development Project of Chongqing’s Technology Innovation and Application Development Special Program in the Field of Big Health (Project Approval Number: CSTC2021jscx-gksb-N0027). The First Clinical College Clinical medicine first-class discipline construction project to department of Breast and Thyroid Surgery (CYYY-BSYJSCXXW-202322). Disclosure The authors declare that they have no conflict of interest. References Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49. Wilkinson L, Gathani T. Understanding breast cancer as a global health concern. Br J Radiol. 2022;95(1130):20211033. Sancho-Garnier H, Colonna M. [Breast cancer epidemiology]. Presse Med. 2019;48(10):1076–84. Feng Y, Spezia M, Huang S, et al. Breast cancer development and progression: Risk factors, cancer stem cells, signaling pathways, genomics, and molecular pathogenesis. Genes Dis. 2018;5(2):77–106. Simion L, Rotaru V, Cirimbei C et al. Inequities in Screening and HPV Vaccination Programs and Their Impact on Cervical Cancer Statistics in Romania. Diagnostics (Basel) 2023; 13(17). Simion L, Chitoran E, Cirimbei C et al. A Decade of Therapeutic Challenges in Synchronous Gynecological Cancers from the Bucharest Oncological Institute. Diagnostics (Basel) 2023; 13(12). Mieog JS, van der Hage JA, van de Velde CJ. Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev 2007; 2007(2):CD005002. Angelos P, Bedrosian I, Euhus DM, et al. Contralateral Prophylactic Mastectomy: Challenging Considerations for the Surgeon. Ann Surg Oncol. 2015;22(10):3208–12. Song J, Zhang X, Liu Q, et al. Impact of neoadjuvant chemotherapy on immediate breast reconstruction: a meta-analysis. PLoS ONE. 2014;9(5):e98225. Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32(9):919–26. Bagnyukova TV, Serebriiskii IG, Zhou Y, et al. Chemotherapy and signaling: How can targeted therapies supercharge cytotoxic agents? Cancer Biol Ther. 2010;10(9):839–53. Bracci L, Schiavoni G, Sistigu A, et al. Immune-based mechanisms of cytotoxic chemotherapy: implications for the design of novel and rationale-based combined treatments against cancer. Cell Death Differ. 2014;21(1):15–25. Ohmoto A, Fuji S. Infection profiles of different chemotherapy regimens and the clinical feasibility of antimicrobial prophylaxis in patients with DLBCL. Blood Rev. 2021;46:100738. Franz MG, Steed DL, Robson MC. Optimizing healing of the acute wound by minimizing complications. Curr Probl Surg. 2007;44(11):691–763. Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res. 2010;89(3):219–29. Asif HM, Sultana S, Ahmed S, et al. HER-2 Positive Breast Cancer - a Mini-Review. Asian Pac J Cancer Prev. 2016;17(4):1609–15. Zhang A, Wang X, Fan C, et al. The Role of Ki67 in Evaluating Neoadjuvant Endocrine Therapy of Hormone Receptor-Positive Breast Cancer. Front Endocrinol (Lausanne). 2021;12:687244. Tse T, Sehdev S, Seely J, et al. Neoadjuvant Chemotherapy in Breast Cancer: Review of the Evidence and Conditions That Facilitated Its Use during the Global Pandemic. Curr Oncol. 2021;28(2):1338–47. Thompson JA, Schneider BJ, Brahmer J, et al. Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(4):387–405. Hart SE, Brown DL, Kim HM, et al. Association of Clinical Complications of Chemotherapy and Patient-Reported Outcomes After Immediate Breast Reconstruction. JAMA Surg. 2021;156(9):847–55. Decker MR, Greenblatt DY, Havlena J, et al. Impact of neoadjuvant chemotherapy on wound complications after breast surgery. Surgery. 2012;152(3):382–8. Mitchem J, Herrmann D, Margenthaler JA, et al. Impact of neoadjuvant chemotherapy on rate of tissue expander/implant loss and progression to successful breast reconstruction following mastectomy. Am J Surg. 2008;196(4):519–22. Gralow JR, Burstein HJ, Wood W, et al. Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. J Clin Oncol. 2008;26(5):814–9. Woeste MR, Bhutiani N, Donaldson M, et al. Evaluating the effect of neoadjuvant chemotherapy on surgical outcomes after breast conserving surgery. J Surg Oncol. 2021;123(2):439–45. Lawrence WT, Talbot TL, Norton JA. Preoperative or postoperative doxorubicin hydrochloride (adriamycin): which is better for wound healing? Surgery. 1986;100(1):9–13. Devereux DF, Thibault L, Boretos J, et al. The quantitative and qualitative impairment of wound healing by adriamycin. Cancer. 1979;43(3):932–8. Sandoo A, Kitas GD, Carmichael AR. Endothelial dysfunction as a determinant of trastuzumab-mediated cardiotoxicity in patients with breast cancer. Anticancer Res. 2014;34(3):1147–51. Kuerer HM, Hunt KK, Newman LA, et al. Neoadjuvant chemotherapy in women with invasive breast carcinoma: conceptual basis and fundamental surgical issues. J Am Coll Surg. 2000;190(3):350–63. Hu YY, Weeks CM, In H, et al. Impact of neoadjuvant chemotherapy on breast reconstruction. Cancer. 2011;117(13):2833–41. Varghese J, Gohari SS, Rizki H, et al. A systematic review and meta-analysis on the effect of neoadjuvant chemotherapy on complications following immediate breast reconstruction. Breast. 2021;55:55–62. Sabitovic A, Trostrup H, Damsgaard TE. The impact of neoadjuvant chemotherapy on surgical outcomes following autologous and implant-based immediate breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2023;87:17–23. Mehrara BJ, Santoro TD, Arcilla E, et al. Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg. 2006;118(5):1100–9. Dolen UC, Schmidt AC, Um GT, et al. Impact of Neoadjuvant and Adjuvant Chemotherapy on Immediate Tissue Expander Breast Reconstruction. Ann Surg Oncol. 2016;23(7):2357–66. Lorentzen T, Heidemann LN, Moller S, et al. Impact of neoadjuvant chemotherapy on surgical complications in breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2022;48(1):44–52. Beugels J, Meijvogel JLW, Tuinder SMH, et al. The influence of neoadjuvant chemotherapy on complications of immediate DIEP flap breast reconstructions. Breast Cancer Res Treat. 2019;176(2):367–75. Bakchoul T, Marini I. Drug-associated thrombocytopenia. Hematology Am Soc Hematol Educ Program 2018; 2018(1):576–583. Kazzam ME, Ng P. Postoperative Seroma Management. In: 37, ed. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Paul Ng declares no relevant financial relationships with ineligible companies.; 2024. Azzawi K, Ismail A, Earl H, et al. Influence of neoadjuvant chemotherapy on outcomes of immediate breast reconstruction. Plast Reconstr Surg. 2010;126(1):1–11. Major Extremity Trauma Research C, O'Toole RV, Joshi M, et al. Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial. JAMA Surg. 2021;156(5):e207259. Nag S, Berlin L, Hunter K, et al. Effects of Neoadjuvant Chemotherapy on Autologous and Implant-Based Breast Reconstruction: A Systematic Review and Meta-Analysis of the Literature. Clin Breast Cancer. 2024;24(3):184–90. Carson CC. Diagnosis, treatment and prevention of penile prosthesis infection. Int J Impot Res. 2003;15(Suppl 5):S139–46. Murphy BD, Kerrebijn I, Farhadi J, et al. Indications and Controversies for Abdominally-Based Complete Autologous Tissue Breast Reconstruction. Clin Plast Surg. 2018;45(1):83–91. Allue Cabanuz M, Del Arribas MD, Gil Romea I, et al. Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: A safe option? Cir Esp (Engl Ed). 2019;97(10):575–81. Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018;34(5):575–84. Warren Peled A, Itakura K, Foster RD, et al. Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction. Arch Surg. 2010;145(9):880–5. Jimenez-Puente A, Prieto-Lara E, Rueda-Dominguez A, et al. Complications in immediate breast reconstruction after mastectomy. Int J Technol Assess Health Care. 2011;27(4):298–304. Barazzuol L, Coppes RP, van Luijk P. Prevention and treatment of radiotherapy-induced side effects. Mol Oncol. 2020;14(7):1538–54. Shen Z, Sun J, Yu Y, et al. Oncological safety and complication risks of mastectomy with or without breast reconstruction: A Bayesian analysis. J Plast Reconstr Aesthet Surg. 2021;74(2):290–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Feb, 2026 Reviews received at journal 30 Jan, 2026 Reviews received at journal 10 Jan, 2026 Reviewers agreed at journal 05 Jan, 2026 Reviewers agreed at journal 05 Jan, 2026 Reviewers agreed at journal 15 Dec, 2025 Reviewers invited by journal 11 Dec, 2025 Editor assigned by journal 01 Dec, 2025 Submission checks completed at journal 01 Dec, 2025 First submitted to journal 26 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8212590","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":560853792,"identity":"02b161d0-9b80-4088-be22-8c8cb318498e","order_by":0,"name":"Chi Zhang","email":"","orcid":"","institution":"Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chi","middleName":"","lastName":"Zhang","suffix":""},{"id":560853794,"identity":"49629f76-d9eb-4e83-93b2-4e9dc24cbc50","order_by":1,"name":"Hailin Yang","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hailin","middleName":"","lastName":"Yang","suffix":""},{"id":560853797,"identity":"5b999957-49e4-4923-844c-f31d13767ba7","order_by":2,"name":"Zheng Zhou","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zheng","middleName":"","lastName":"Zhou","suffix":""},{"id":560853801,"identity":"8173ea43-3509-4df0-8360-da57c5e3139a","order_by":3,"name":"Jihan Qiu","email":"","orcid":"","institution":"Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jihan","middleName":"","lastName":"Qiu","suffix":""},{"id":560853804,"identity":"9743e3a1-452d-487b-9a6d-54c8089933f9","order_by":4,"name":"Hanzhi Li","email":"","orcid":"","institution":"Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hanzhi","middleName":"","lastName":"Li","suffix":""},{"id":560853811,"identity":"4dd6a5e4-e4b0-427a-abf2-b4e77f63e0af","order_by":5,"name":"Haochen Yu","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haochen","middleName":"","lastName":"Yu","suffix":""},{"id":560853812,"identity":"200cdb98-be90-4e02-a2a2-35ebf93848b9","order_by":6,"name":"Shengchun Liu","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shengchun","middleName":"","lastName":"Liu","suffix":""},{"id":560853815,"identity":"b47d468e-90f4-456d-9596-79d95eb42fb2","order_by":7,"name":"Lingfeng Tang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYFAC5gYGxgYwi/EBgwERGnhA6qFamA1I1sImQZSz7NkbGx8X7rDJ4xc7fKzyR8EdeQb2w0c34LWF52Cz8cwzacWSs9PSbvMYPDNs4ElLu4FXi0RimzRv2+HEDbdzzG4zGBxmbJDgMcOvRf5h+2+Qlv23878V/jA4bE9YiwRjGzPYFukcNgYeg8OJhLWcSWyWntmWljjjdpqxNFBLchshv7C3Hz74ubDNJrF/dvLDjz/+HLbtZz98DK8WEGBG4bERUo6pZRSMglEwCkYBOgAAJCtLYCoHp8AAAAAASUVORK5CYII=","orcid":"","institution":"Chongqing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Lingfeng","middleName":"","lastName":"Tang","suffix":""}],"badges":[],"createdAt":"2025-11-26 11:53:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8212590/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8212590/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98747522,"identity":"7992901b-c0e1-44ec-9f53-b7320d3d706d","added_by":"auto","created_at":"2025-12-22 08:52:43","extension":"tif","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1341020,"visible":true,"origin":"","legend":"","description":"","filename":"Figure2.tif","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/73b6c09b4701e2e729ddd86f.tif"},{"id":98747519,"identity":"cf5a4388-b7e1-47a1-87ba-bbe6ca0203e7","added_by":"auto","created_at":"2025-12-22 08:52:43","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12980,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/57aeb94780512d228bf02560.xlsx"},{"id":98777722,"identity":"fd5ebae0-aaf2-4304-b889-448f1c6efb9e","added_by":"auto","created_at":"2025-12-22 12:28:23","extension":"tif","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5804098,"visible":true,"origin":"","legend":"","description":"","filename":"Figure3.tif","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/aff394ebf5a56f58d7518542.tif"},{"id":98779006,"identity":"57f8d81f-6e03-4ca7-b94c-d9c27a1c114f","added_by":"auto","created_at":"2025-12-22 12:29:52","extension":"json","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9321,"visible":true,"origin":"","legend":"","description":"","filename":"08185f5d83db45978658c1081aa05903.json","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/2fba5f1df5542827cb956ecc.json"},{"id":98777103,"identity":"f046b74b-c6d9-4e4b-9318-8c340482c002","added_by":"auto","created_at":"2025-12-22 12:25:22","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":148770,"visible":true,"origin":"","legend":"","description":"","filename":"08185f5d83db45978658c1081aa059031enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/8e26c49b1b56a454f7c9378f.xml"},{"id":98778429,"identity":"f02bbf7f-274a-47c1-a0dd-befc85e12875","added_by":"auto","created_at":"2025-12-22 12:29:15","extension":"tif","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4180319,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1.tif","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/08e8e6732a5fa069ddc8b3c6.tif"},{"id":98747527,"identity":"8e33f265-b20c-4e48-b995-b7ad2dbc92c9","added_by":"auto","created_at":"2025-12-22 08:52:43","extension":"tif","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1341020,"visible":true,"origin":"","legend":"","description":"","filename":"Figure2.tif","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/3756ebfb123c42232f2f00b1.tif"},{"id":98779618,"identity":"05f2468d-4d52-4f6d-aeb0-aab27d82e4de","added_by":"auto","created_at":"2025-12-22 12:30:32","extension":"tif","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5804098,"visible":true,"origin":"","legend":"","description":"","filename":"Figure3.tif","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/df1ad9f1208346c4137c2efc.tif"},{"id":98747523,"identity":"61b35c04-ca8f-464d-851d-4b89a1cf9fb0","added_by":"auto","created_at":"2025-12-22 08:52:43","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":185851,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/05c6a852f18c63f8f97d2582.png"},{"id":98747520,"identity":"f85d92c0-cc23-4110-9b51-e7733710a5e9","added_by":"auto","created_at":"2025-12-22 08:52:43","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":32703,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/56d3eb58f1e90923bdf03f35.png"},{"id":98747529,"identity":"db6c5b33-6ee9-473d-aa35-d8d21abaa751","added_by":"auto","created_at":"2025-12-22 08:52:43","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":145870,"visible":true,"origin":"","legend":"","description":"","filename":"08185f5d83db45978658c1081aa059031structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/b34093cba77362ef8146005d.xml"},{"id":98777422,"identity":"ff43f898-1cfe-469c-b5c0-4b83abfb8ae1","added_by":"auto","created_at":"2025-12-22 12:27:04","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":156715,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/26955a1a5180385d1d9f819b.html"},{"id":98747516,"identity":"d5d7a1de-53d3-48d3-b52a-a8803e190aa2","added_by":"auto","created_at":"2025-12-22 08:52:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":188317,"visible":true,"origin":"","legend":"\u003cp\u003eFlow-chart shows the process of including patients in the study.\u003c/p\u003e","description":"","filename":"Figure11.png","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/31d1041b405c8ed07eba9a69.png"},{"id":98777469,"identity":"fd0ba126-3f04-475a-ad48-447d1fa771fd","added_by":"auto","created_at":"2025-12-22 12:27:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":448586,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of various details in Breast-Q with or without neoadjuvant chemotherapy.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/56a4b8582bd0c911af59c4a7.png"},{"id":98777224,"identity":"66201ad7-314d-4c09-9e1f-1382bbee5551","added_by":"auto","created_at":"2025-12-22 12:26:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":124794,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival analyses for 5-year disease-free survival based on\u003cstrong\u003e \u003c/strong\u003eNACT.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/49a01f016d0db6d259a7bb04.png"},{"id":98783410,"identity":"c3639bba-8bf3-452e-a343-4194dbadc301","added_by":"auto","created_at":"2025-12-22 12:41:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1747014,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8212590/v1/884b7362-e7ff-4da7-a027-76aeac96d477.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Implant-Based Breast Reconstruction: A Single-Center Retrospective Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIn 2020, breast cancer, which consists of various malignancies in the mammary glands, accounted for approximately 2.26\u0026nbsp;million cases, ranking as the primary cause of cancer-related deaths among females\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The global age-standardized incidence rate for females is approximately 48 per 100,000, varying from under 30 per 100,000 in sub-Saharan Africa to over 70 per 100,000 in Western Europe and North America\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. It is noteworthy that mortality rates have been declining for over thirty years, with average survival rates of 86% at five years and 75% at ten years\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Breast cancer is predominantly composed of adenocarcinomas; specifically, about 85% originate from ductal epithelium while others arise from lobular epithelium\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. According to histological characteristics, these can be grouped into four subtypes: Luminal A, Luminal B, HER-2 positive, and triple-negative (TNBC). This epidemiological trend and the classification of breast cancer types have both contributed to improvements in oncological treatments such as neoadjuvant chemotherapy and endocrine therapy as well as early management strategies for neoplasms related to breast cancer\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNeoadjuvant chemotherapy treatment (NACT) is a form of adjuvant therapy that administers chemotherapy prior to surgical intervention. This approach allows for early assessment of therapeutic response and may facilitate tumor downstaging. Consequently, this enhances the feasibility of tumor resection and increases surgical options available to patients\u0026mdash;including mastectomy and breast-conserving surgery\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe rise in life expectancy and increased aesthetic awareness among women have led to a higher frequency of breast reconstructions following mastectomy. There is a notable trend towards immediate Implant-Based Reconstruction (IBR), which includes single-stage direct-to-implant (DTI) procedures as well as two-staged tissue expander/implant (TE/I) approaches\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Additionally, the surge in prophylactic mastectomies, driven by genetic susceptibility to breast cancer or a family history, has also resulted in more breast reconstruction operations\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, NACT may have adverse effects on breast reconstruction outcomes, as chemotherapeutic agents target proliferating cells by inducing apoptosis, necrosis, and death of cancerous tissue\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Chemotherapy not only undermines wound strength and healing through detrimental impacts on cell division and metabolism, angiogenesis, and protein synthesis but can also lead to transient aplastic anemia. This condition hampers normal inflammatory responses to trauma, thereby increasing the risks of wound infections, flap necrosis, and other complications\u003csup\u003e\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite these concerns, the influence of NACT on surgical complication rates following prosthetic reconstruction remains underexplored\u0026mdash;particularly regarding patients\u0026rsquo; satisfaction among those who underwent NACT with their prosthesis. As a result, we examined breast reconstruction records at our facility to compare the rates of complications, BREAST-Q scores, and three-year survival outcomes between patients undergoing prosthetic reconstruction after NACT and a control group that received skin-sparing mastectomy followed by prosthetic reconstruction without NACT. Our aim was to determine whether NACT significantly impacts IBR, thereby providing insights for clinical practice.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Patients\u003c/h2\u003e \u003cp\u003eThe clinical databases of the First Affiliated Hospital of Chongqing Medical University were used to obtain medical records of breast cancer patients treated from January 1, 2008, to December 31, 2019. Approval for this retrospective study was granted by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (Reference No. 2020\u0026thinsp;\u0026minus;\u0026thinsp;202). All processes were carried out following the applicable guidelines. Criteria for inclusion: (I) Female; (II) Invasive breast cancer confirmed by pathological examination; (III) Received IBR (DTI/TE/I) with or without neoadjuvant chemotherapy; (IV) No prior anti-tumor treatment. Exclusion criteria: (I) Metastasis at diagnosis; (II) Presence of other primary tumors; (III) Bilateral breast cancer; (IV) Incomplete data; and (V) Incomplete neoadjuvant chemotherapy period. In conclusion, 618 patients who met the eligibility requirements were included in this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAll tissue samples were embedded in paraffin and examined by two seasoned pathologists. This article does not address patient privacy; therefore, informed consent was deemed unnecessary. All data were fully anonymized prior to our access. The authors were not provided with any personally identifiable data at any stage of the data collection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Clinicopathological analysis\u003c/h2\u003e \u003cp\u003eIn total, 622 eligible patients were ultimately included for further analysis. This cohort comprised 233 patients who received IBR following NACT as well as patients who received IBR without prior NACT. To comprehensively analyze the efficacy and satisfaction of IBR, we collected general information including age, body mass index (BMI), history of diabetes, menstrual status, and NACT regimens. Additionally, clinicopathological data were gathered encompassing tumor stage (stage_T and stage_N), estrogen receptor (ER) status, progesterone receptor (PgR) status, HER2 status, Ki67 index, and P53 status.\u003c/p\u003e \u003cp\u003eClinical assessments related to breast cancer, including lymph node involvement (stage_N) and tumor size (stage_T), were determined through magnetic resonance imaging (MRI) or breast ultrasonography. The evaluation of ER, PgR, HER2 expression levels, Ki67 index, and P53 status was conducted using immunohistochemistry (IHC) on samples obtained via core needle biopsy.\u003c/p\u003e \u003cp\u003eHER2 negative status was defined by an IHC score of 0 or 1+, or a score of 2\u0026thinsp;+\u0026thinsp;with non-amplified fluorescence in situ hybridization (FISH)\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Conversely, HER2 positive status was characterized by high levels of HER2 expression indicated by an IHC score of 3+, or a score of 2\u0026thinsp;+\u0026thinsp;with amplified FISH results. Samples exhibiting more than 1% positivity for ER/PgR expression were classified as ER-positive/PgR-positive. The Ki67 index was calculated as the percentage of tumor cells displaying nuclear staining across at least ten high-powered fields at \u0026times;40 magnification from a minimum total count of 1000 tumor cells\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Treatment\u003c/h2\u003e \u003cp\u003eBreast cancer patients were considered for NACT if they presented with advanced-stage disease, including involvement of axillary lymph nodes, sizable tumors, or infiltration of the skin or chest wall\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. NACT was administered based on local protocols and relevant international guidelines in effect at the time. The treatments primarily consisted of anthracycline and taxane-based regimens. The TEC regimen (docetaxel 75 mg/m\u0026sup2;, epirubicin 75 mg/m\u0026sup2;, and cyclophosphamide 500 mg/m\u0026sup2;) or EC regimen (epirubicin 75 mg/m\u0026sup2; and cyclophosphamide 500 mg/m\u0026sup2;) was administered every three weeks. For HER2 positive patients, trastuzumab-based chemotherapy (8 mg/kg for the first dose; 6 mg/kg for subsequent doses) was given every three weeks for a total of six cycles prior to surgery. Surgery was performed two weeks after completion of the full treatment regimen\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAll participants in our study underwent surgery following standardized procedures consistent with the guidelines set forth by CSCO and NCCN\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Mastectomy involved resection of the areolar complex, ensuring optimal removal of all mammary glandular tissue. Patients in the NACT group (n\u0026thinsp;=\u0026thinsp;233), who had confirmed pathological evidence of metastatic axillary lymph nodes prior to NACT, received axillary lymph node dissection (ALND). Conversely, other participants in either the NACT group or control group were required to complete sentinel lymph node biopsy (SLNB) to determine eligibility for ALND.\u003c/p\u003e \u003cp\u003eFollowing skin-sparing mastectomy, a subpectoral cavity was created to facilitate implantation of either a permanent endoprosthesis or a temporary tissue expander. Patients undergoing ALND had temporary tissue expanders placed during post-mastectomy radiotherapy (PMRT), which were subsequently replaced by prosthesis upon completion of PMRT. In contrast, other patients received immediate breast reconstruction using prosthesis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Complications\u003c/h2\u003e \u003cp\u003eAll major complications that occurred one year after surgery were recorded for each reconstructed breast as primary endpoints. Major complications were characterized by the occurrence of any of the following events: (I) implant/expander loss (I/E); (II) skin flap necrosis; and (III) distant recurrence\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Minor complications were considered present if any of the following occurred: (I) wound breakdown; (II) hematoma; (III) seroma; (IV) fat necrosis; and (V) infection\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Implant loss was defined as the removal of a prosthesis without any immediate replacement. Skin flap necrosis was characterized by a loss of elasticity in the flap, accompanied by blackening and pain due to ischemia. Hematoma denoted an intramammary blood collection that warranted operative management. A seroma referred to tissue fluid accumulation beneath the skin necessitating aspiration. Infection was identified by localized or systemic evidence that required antibiotic administration. Distant recurrence was defined as confirmed evidence of neoplasm occurring in organs other than the breast in patients who had no metastasis prior to surgery but developed it post-reconstruction. We meticulously examined all collected complications along with the time interval between surgery and reconstruction for each patient for subsequent analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Objective\u003c/h2\u003e \u003cp\u003eThe secondary outcome measured was the change in quality of life (QoL) at 12 months. The BREAST-Q (v2.0), which evaluates QoL, covers various aspects including satisfaction with breast appearance and outcomes, sexual well-being, physical well-being of the chest, and psychosocial well-being\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Participants completed the questionnaire at reconstruction surgery, as well as six and twelve months afterward.\u003c/p\u003e \u003cp\u003eAfter the reconstruction procedure, we attempted to contact each patient using the information provided at their initial admission to our hospital. Detailed records regarding their health conditions and life status were maintained. In cases where patients could not be reached, we opted to contact their designated guardians, who served as points of reference during the patients' medical treatment in our facility. Patients or guardians who could not be contacted were excluded from further consideration. The 5-year disease-free survival rate was calculated next, considering DFS as the duration from surgery to any relapse, secondary malignancy, or all-cause mortality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Statistical methods\u003c/h2\u003e \u003cp\u003eData analysis was carried out using SPSS (Version 25.0). The chi-squared test or Fisher\u0026rsquo;s exact test was applied to categorical variables, while continuous variables were evaluated with the t-test. The Kaplan-Meier method was employed to estimate follow-up data, while univariate and multivariate regression analyses identified factors associated with complications. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was deemed significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline clinicopathological characteristics of patients between the two groups\u003c/h2\u003e \u003cp\u003eThe basic characteristics of the patients are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. From 2008 to 2019, 233 patients underwent NACT followed by prosthesis breast reconstruction, while 329 patients received prosthesis breast reconstruction without NACT. A median follow-up of 84 months was recorded, during which significant differences emerged between the groups regarding age, N stage, histological grade, Ki-67 index, and clinical stage. Notably, patients undergoing NACT were generally younger (P\u0026thinsp;=\u0026thinsp;0.027), exhibited higher histological grades (P\u0026thinsp;=\u0026thinsp;0.001), advanced T_stage (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and showed more advanced axillary lymph node involvement (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, The Ki-67 index was also markedly greater in patients receiving NACT versus those who did not (P\u0026thinsp;=\u0026thinsp;0.011). Moreover, patients in the NACT group were more likely to undergo two-staged tissue expander/implant (TE/I) procedures (P\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline clinicopathological characteristics of patients undergoing breast reconstruction surgery.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;562)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-NACT (n\u0026thinsp;=\u0026thinsp;329)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNACT (n\u0026thinsp;=\u0026thinsp;233)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e391(69.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e217(66.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e174(74.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171(30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112(34.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59(25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e443(78.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e260(79.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e183(78.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119(21.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69(21.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50(21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithout\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e507(90.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e296(90.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e211(90.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22(9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMenopausal status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremenopausal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e397(70.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234(71.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e163(70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostmenopausal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165(29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95(28.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70(30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e279(49.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159(48.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120(51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e283(50.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e170(51.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e113(48.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e292(52.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234(71.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58(24.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e248(44.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93(28.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e155(66.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ/Ⅳ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20(8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e421(74.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e287(87.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e134(57.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102(18.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41(12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61(26.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39(6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38(16.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistological grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e484(86.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e295(89.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e189(81.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68(12.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42(18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e152(27.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89(27.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63(27.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e410(73.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e240(72.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e170(73.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePgR status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e214(38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117(35.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97(41.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e348(61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e212(64.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e136(58.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHER2 status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e445(79.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e259(78.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e186(79.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117(20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70(21.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47(20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP53 status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e283(50.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e156(47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e127(54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e279(49.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173(52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e106(45.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKi-67(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e247(44.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162(49.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85(36.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(20, 50]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e251(44.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134(40.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e117(50.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64(11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31(13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReconstruction mode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e401(71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e218(66.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e183(78.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e161(28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111(33.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50(21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuffered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78(13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35(15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e484(86.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e283(86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e198(85.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReccurence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuffered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(7.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30(12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e507(90.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e304(92.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e203(87.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMI Body Mass Index, ER estrogen receptor, PgR progesterone receptor, NACT neoadjuvant chemotherapy\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e values were determined by chi-square tests. Bold values indicate statistical significance (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Complications and influencing factors\u003c/h2\u003e \u003cp\u003eAt the outset, the incidence of total complications was comparable between the non-NACT and NACT groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In univariate analysis, age (P\u0026thinsp;=\u0026thinsp;0.016), diabetes (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and T stage (P\u0026thinsp;=\u0026thinsp;0.027) were identified as factors associated with total complications. Consequently, these variables were incorporated into the subsequent multivariate analysis. The findings revealed that diabetes (P\u0026thinsp;=\u0026thinsp;0.001) and T stage (P\u0026thinsp;=\u0026thinsp;0.019) independently predicted total complications (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetail data showing the complications.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHematomas\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSeromas\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eImplant loss\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFat necrosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eWound breakdown\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSkin-flap necrosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurgical re-intervention\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-NACT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46/329\u003c/p\u003e \u003cp\u003e(13.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12/329\u003c/p\u003e \u003cp\u003e(3.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7/329\u003c/p\u003e \u003cp\u003e(2.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27/329\u003c/p\u003e \u003cp\u003e(8.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31/329\u003c/p\u003e \u003cp\u003e(9.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3/329\u003c/p\u003e \u003cp\u003e(0.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10/329\u003c/p\u003e \u003cp\u003e(3.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12/329\u003c/p\u003e \u003cp\u003e(3.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e45/329\u003c/p\u003e \u003cp\u003e(13.68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNACT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35/233\u003c/p\u003e \u003cp\u003e(15.02%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16/233\u003c/p\u003e \u003cp\u003e(6.87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14/233\u003c/p\u003e \u003cp\u003e(6.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24/233\u003c/p\u003e \u003cp\u003e(10.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24/233\u003c/p\u003e \u003cp\u003e(10.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8/233\u003c/p\u003e \u003cp\u003e(3.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6/233\u003c/p\u003e \u003cp\u003e(2.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17/233\u003c/p\u003e \u003cp\u003e(7.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e32/233\u003c/p\u003e \u003cp\u003e(13.73%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate analyses of total complications and clinicopathological characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eUnivariate analysis HR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eMultivariate analysis HR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years (\u0026ge;\u0026thinsp;45 vs\u0026thinsp;\u0026lt;\u0026thinsp;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (\u0026ge;\u0026thinsp;24 vs\u0026thinsp;\u0026lt;\u0026thinsp;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes (With vs Without)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e5.766\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMenopausal status (Postmenopausal vs Premenopausal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location (Left vs Right)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecT3/cT4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN stage (Nx vs N0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTherapeutic strategies (NACT vs non-NACT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReconstruction mode (IBR vs two-staged)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistological grade (Ⅲ vs Ⅰ/Ⅱ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eER status (Positive vs Negative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePgR status (Positive vs Negative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHER2 status (Positive vs Negative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP53 status (wild vs Mutant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKi-67 (\u0026gt;50% vs\u0026thinsp;\u0026le;\u0026thinsp;50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Major complications\u003c/h2\u003e \u003cp\u003eAmong 233 patients who received NACT before IBR, implant loss occurred in 10.3% (N\u0026thinsp;=\u0026thinsp;24/233) of patients, compared to 9.4% (N\u0026thinsp;=\u0026thinsp;27/329) in the non-NACT group (P\u0026thinsp;=\u0026thinsp;0.730). The incidence of skin-flap necrosis was significantly higher among patients receiving NACT with a rate of 7.32% (N\u0026thinsp;=\u0026thinsp;17/233) compared to 3.36% (N\u0026thinsp;=\u0026thinsp;12/329) in the non-NACT group ( P\u0026thinsp;=\u0026thinsp;0.034). Additionally, there was no statistically significant difference in the need for surgical intervention between the two groups, with rates of 13.73% (N\u0026thinsp;=\u0026thinsp;32/233) and 13.68% (N\u0026thinsp;=\u0026thinsp;45/329), respectively (P\u0026thinsp;=\u0026thinsp;0.985).\u003c/p\u003e \u003cp\u003eBoth univariate and multivariate analyses demonstrated that T stage (P\u0026thinsp;=\u0026thinsp;0.017) independently influenced implant loss, while diabetes (P\u0026thinsp;=\u0026thinsp;0.047) and T stage (P\u0026thinsp;=\u0026thinsp;0.001) were independently associated with skin-flap necrosis. Multivariate analysis also indicated that diabetes (P\u0026thinsp;=\u0026thinsp;0.002) was a significant factor influencing the need for surgical intervention (\u003cb\u003eSupplement\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Minor complications\u003c/h2\u003e \u003cp\u003eReceipt of NACT was significantly linked to a higher risk of seroma formation (P\u0026thinsp;=\u0026thinsp;0.017). The analysis revealed no statistically meaningful variation in rates of fat necrosis (P\u0026thinsp;=\u0026thinsp;0.069), infections (P\u0026thinsp;=\u0026thinsp;0.395), wound breakdown (P\u0026thinsp;=\u0026thinsp;0.744), or hematoma (P\u0026thinsp;=\u0026thinsp;0.084) between the two groups.\u003c/p\u003e \u003cp\u003eSeroma formation was independently influenced by tumor location and T stage, as shown by univariate and multivariate analyses (P\u0026thinsp;=\u0026thinsp;0.042 and P\u0026thinsp;=\u0026thinsp;0.004, respectively). Additionally, T stage (P\u0026thinsp;=\u0026thinsp;0.009) was independently associated with hematoma. For infections, diabetes (P\u0026thinsp;=\u0026thinsp;0.024) was identified as an independent factor. Furthermore, age (P\u0026thinsp;=\u0026thinsp;0.008) and T stage (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were found to be independent factors for wound breakdown (\u003cb\u003eSupplement\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Evaluation of patients' satisfaction with breast reconstruction\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the outcomes of different BREAST-Q domains, stratified by treatment group. Total scores did not differ between the NACT and non-NACT groups (P\u0026thinsp;=\u0026thinsp;0.991). More precisely, the groups did not differ significantly in three domains: satisfaction with breast (P\u0026thinsp;=\u0026thinsp;0.599), sexual well-being (P\u0026thinsp;=\u0026thinsp;0.990), and psychological well-being (P\u0026thinsp;=\u0026thinsp;0.616). Notably, patients in the NACT group reported better chest physical well-being than those in the non-NACT group, a difference that reached statistical significance (P\u0026thinsp;=\u0026thinsp;0.005; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cdiv\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e3.4 Survival analysis of patients\u003c/p\u003e\n\u003cp\u003eIn our cohorts, the median follow-up time was 86 months for the non-NACT group and 83 months for the NACT group. Notably, 12.9% (N = 30/233) of patients who received NACT experienced recurrence within 5 years after breast reconstruction, which was significantly higher than the 7.6% (N = 25/329) recurrence rate in the control group (P = 0.038). The non-NACT group showed a superior DFS rate of 92.4% (304 of 329 patients) versus 87.1% (203 of 233 patients) in the NACT group, a statistically significant difference (P = 0.020; Fig. 3).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eDespite its growing role in making surgery feasible for advanced breast cancer patients, the effects of NACT on perioperative and long-term outcomes remain uncertain\u0026mdash;especially in the context of breast reconstruct\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Chemotherapy's mechanism of targeting proliferating cells and interfering with their specific processes suppresses the immune system, thereby impairing wound healing and increasing infection susceptibility. Experimental findings consistently indicate a reduction in wound tensile strength following chemotherapy treatment\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. The impact of agents such as anthracyclines on endothelial cells is well established, with potential consequences including an elevated risk of thrombosis and subsequent major or minor complications\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Despite their significance, these effects remain underexplored in clinical settings, necessitating further investigation into the influence of NACT on patients receiving IBR\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. One notable finding indicated that the odds of undergoing immediate breast reconstruction are significantly reduced in women treated with NACT, even after adjusting for factors such as age, disease stage, and postoperative\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. This difference may be attributed to surgeons' concerns about potential complications, leading to fewer IBR in clinical practice. Conversely, Jajini Varghese et al. assessed 3,249 patients who underwent immediate breast reconstruction and reported no significant increase in postoperative complication risk associated with NACT (RR 0.91, 95% CI 0.74\u0026ndash;1.11, p\u0026thinsp;=\u0026thinsp;0.34)\u003csup\u003e30\u003c/sup\u003e. In a comparable finding, a recent meta-analysis concluded that NACT had no significant impact on the incidence of major or minor complications after IBR, whether performed with autologous tissue or implants\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Notably, the patient cohorts in these studies comprised individuals undergoing TE/I or autologous flap reconstruction, irrespective of whether they received post-mastectomy radiation therapy (PMRT). In light of the uncertainty surrounding the impact of NACT on IBR outcomes, a number of studies have been undertaken to further investigate the issue. In this study, we set out to access the impact of the NACT on IBR to better indicate clinical use of breast reconstruction surgical patterns.\u003c/p\u003e \u003cp\u003eFindings from this study suggest that preoperative NACT does not influence the overall incidence of complications following IBR, as no statistically significant differences were observed in major or minor complication rates between the two patient groups. This finding aligns with the results of a retrospective review conducted by Mehrara et al., which reached a similar conclusion\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Similarly, a meta-analysis by Jajini Varghese et al. found minimal evidence of a difference in overall complication rates between women treated with NACT and those who were not\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Conversely, Dolen et al. analyzed 889 patients with TE/I, of whom 295 received NACT, and found significantly higher complication rates among NACT patients compared to those who did not receive NACT\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Our analysis revealed statistically significant differences in the incidence of certain complications between the NACT and non-NACT cohorts; however, multivariate analysis demonstrated that NACT was not an independent predictor of these outcomes.\u003c/p\u003e \u003cp\u003eThe minor complications observed in this study included seroma, hematoma, wound breakdown, and fat necrosis. The administration of NACT may compromise blood supply to the surgical area, inhibit cellular recovery, and impair wound healing\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Consequently, the selection of reconstruction methods for these patients should be approached with greater caution. Apart from seroma, no significant differences were noted in other complications between the two groups. Conversely, a meta-analysis reported that none of the included studies demonstrated a significant association between NACT and the incidence of seroma\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Notably, Beugel et al. reported lower rates of minor complications among women who received NACT prior to surgery, which contradicts theoretical expectations. The authors attributed this observation to the younger age of patients in the NACT group and the higher prevalence of active smokers in the control group\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Univariate analysis identified T stage (P\u0026thinsp;=\u0026thinsp;0.002), NACT (P\u0026thinsp;=\u0026thinsp;0.022), tumor location (P\u0026thinsp;=\u0026thinsp;0.049), menopausal status (P\u0026thinsp;=\u0026thinsp;0.023), and diabetes (P\u0026thinsp;=\u0026thinsp;0.036) as potential risk factors. However, multivariate analysis indicated that NACT does not serve as an independent risk factor for seroma formation; rather, tumor location and T stage are significant predictors. Given that the right arm is the preferred side for most people, attention should be paid to the tension of the skin flap for larger masses, and movement of the affected limb should be minimized in the short-term following surgery. Besides, chemotherapy can induce coagulation disorders, potentially contributing to seroma formation\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Furthermore, premature extubation leading to the early removal of drains may result in fluid accumulation and subsequently seroma formation. Therefore, surgeons are advised to regularly assess drainage output and remove drainage tubes appropriately after surgery\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. With respect to wound breakdown, our study demonstrated no significant difference in the incidence between patients who received NACT prior to mastectomy and IBR and those who did not. Consistently, Decker et al. reported a trend toward a modest increase in wound complications among patients who received NACT prior to mastectomy and IBR; however, this association did not reach statistical significance (OR\u0026thinsp;=\u0026thinsp;1.58; 95% CI: 0.98\u0026ndash;2.58)\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Similarly, a meta-analysis by Jajini Varghese et al. indicated that NACT administration was not associated with a significantly higher risk of wound breakdown\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Conversely, Az-Zawi et al. documented an elevated rate of wound-related complications among patients undergoing NACT (10%) relative to those who did not receive NACT (6%)\u003csup\u003e38\u003c/sup\u003e. As we assumed, the regular use of antibiotics during and after surgery may help reduce infection rates, thereby preventing wound breakdown\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Additionally, the surgeons at our center have undergone professional training in suturing techniques, which ensures effective wound healing and may contribute to the lower incidence of wound breakdown observed in our center. According to multivariate analysis, age (P\u0026thinsp;=\u0026thinsp;0.008) and T stage (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) appear to be significant factors influencing wound breakdown, potentially explaining the findings from Az-zawi et al. Furthermore, chemotherapeutic agents have been implicated in the disruption of extracellular matrix remodeling by impairing collagen production, thereby prolonging the wound healing process and heightening the risk of wound dehiscence\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Accordingly, the effects of neoadjuvant chemotherapy on postoperative wound integrity necessitate further comprehensive assessment. Regarding other minor complications, this study did not find a statistically significant association between NACT and hematoma (P\u0026thinsp;=\u0026thinsp;0.084), infection (P\u0026thinsp;=\u0026thinsp;0.395), or fat necrosis (P\u0026thinsp;=\u0026thinsp;0.069). Although lower rates of minor complications were observed among patients without NACT, these differences were not statistically significant. Song et al. reported that administration of neoadjuvant chemotherapy did not significantly influence the incidence of minor postoperative complications, including hematoma, implant-related infections, partial flap necrosis, or complete flap failure\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. In a similar vein, Shayoni Nag et al. observed no statistically significant variation in the occurrence of minor complications between patients treated with neoadjuvant chemotherapy and those who were not\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. The meta-analysis by Jajini Varghese et al. further confirmed that the frequency of hematoma was comparable between patients who received NACT and those who did not, with a risk ratio of 0.99 (95% confidence interval: 0.61 to 1.60; p\u0026thinsp;=\u0026thinsp;0.97)\u003csup\u003e30\u003c/sup\u003e. Conversely, a retrospective review indicated that patients treated with NACT prior to IBR had a significantly higher incidence of fat necrosis\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Therefore, larger clinical trials may be necessary to further evaluate the impact of NACT on minor complications.\u003c/p\u003e \u003cp\u003eIn our study, major complications following immediate breast reconstruction encompassed implant loss, skin flap necrosis, and the requirement for additional surgical intervention. Several factors may contribute to the occurrence of these major complications. Firstly, minor complications are clinically significant in immediate breast reconstruction, as delayed wound healing, infection, and dehiscence can predispose patients to implant loss and additional adverse outcomes\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. Moreover, numerous complications\u0026mdash;particularly those related to wound healing\u0026mdash;are challenging to accurately assess in retrospective studies, potentially leading to underestimation of their true incidence\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Secondly, inappropriate sizing of the prosthesis, excessive tension, and incorrect suture selection can also contribute to implant loss. Lastly, inadequate assessment of patients' underlying conditions, such as diabetes, obesity, and smoking, can increase the risk of major complications\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. The outcomes of our investigation demonstrate that the frequency of significant postoperative complications does not differ substantially between patients administered neoadjuvant chemotherapy and those who did not receive such treatment. However, our findings indicate that patients who received NACT are more likely to develop skin-flap necrosis (P\u0026thinsp;=\u0026thinsp;0.034). Corroborating this, Lorentzen et al.\u0026rsquo;s meta-analysis identified a heightened risk of skin flap necrosis in patients receiving immediate breast reconstruction subsequent to neoadjuvant chemotherapy\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Conversely, the study by Ajla Sabitovic et al. revealed no significant relationship between the administration of neoadjuvant chemotherapy and the development of skin flap necrosis\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Notably, Allu\u0026eacute; Caba\u0026ntilde;uz et al. reported a decreased occurrence of skin flap necrosis in the cohort of patients who received neoadjuvant chemotherapy\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. Our multivariate analysis demonstrated that both diabetes mellitus and clinical T classification serve as independent risk factors for the development of skin flap necrosis (P\u0026thinsp;=\u0026thinsp;0.047 and P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). Excessive tumor volume may lead to excessive flap detachment, while metabolic disorders caused by diabetes can affect skin growth and repair\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. It still requires further evaluation. As for implant-loss, the current study found that the incidence of it was comparable between the two groups. Similarly, Song et al. found no evidence that neoadjuvant chemotherapy elevated the risk of implant loss in women undergoing immediate breast reconstruction\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. In line with this, Peled et al. also reported no significant association between implant loss and the administration of neoadjuvant chemotherapy\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. Interestingly, a significantly higher proportion of patients in the NACT group received PMRT after surgery in this study. Despite this disparity, the incidence of implant loss did not appear to increase among those who received neoadjuvant chemotherapy. In contrast, Jim\u0026eacute;nez-Puente et al. reported a substantially higher rate of expander/implant (E/I) loss in the NACT group (7 of 13 cases) compared to the non-NACT group (19 of 102 cases), corresponding to an odds ratio of 5.10 (P\u0026thinsp;=\u0026thinsp;0.004)\u003csup\u003e46\u003c/sup\u003e. Furthermore, the pooled results from a meta-analysis conducted by J. Varghese et al., which evaluated data from five studies, indicated that implant loss was more likely to occur in patients receiving NACT. However, these results may be influenced by other adjuvant therapies such as PMRT\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. In our study, primary tumor size emerged as the main influencing factor for implant loss. It is hypothesized that the huge size of the tumors may be apt to influence the elasticity and blood supply of the skin around them further attributing to the implant loss. Finally, our analysis revealed no statistically significant elevation in the frequency of secondary surgical procedures among patients who received neoadjuvant chemotherapy. This conclusion is consistent with findings from two meta-analyses conducted by Ajla Sabitovic et al. and Song et al\u003csup\u003e9, 31\u003c/sup\u003e. A possible explanation for the comparable rates of surgical intervention may be the regular long-term follow-up, which provides surgeons with detailed postoperative information, allowing them to address patient issues promptly. Major complications are often the result of minor complications. Therefore, proper use of antibiotics, minimizing flap tension, and maintaining blood glucose control are crucial for reducing the incidence of minor complications.\u003c/p\u003e \u003cp\u003eThis study identified no significant variation in BREAST-Q outcomes across most domains, with the sole exception of the Chest Physical Well-being subscale, which demonstrated a statistically meaningful difference. Patients who did not receive NACT had significantly higher scores in this domain compared to those who received NACT. A plausible explanation is that the NACT cohort primarily comprised individuals with more advanced-stage breast cancer, for whom adjuvant radiotherapy was more frequently indicated. The side effects of radiotherapy, such as peeling, swelling, and ulceration, may negatively impact patient satisfaction. Additionally, the difference in this domain may be attributed to reduced breast sensation and/or potential recurrence\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. Furthermore, we observed a statistically significant higher 5-year recurrence-free survival (RFS) rate in the NACT group compared to patients who did not receive NACT. Nonetheless, a Bayesian evaluation by Shen et al. demonstrated favorable overall survival (OS) outcomes in individuals undergoing neoadjuvant chemotherapy followed by mastectomy and immediate breast reconstruction, despite the presence of selection bias\u0026mdash;specifically, the control group comprised significantly younger patients\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. In our analysis, the more advanced clinical staging observed in the NACT cohort may partially account for the less favorable outcomes documented in this group. Meanwhile, the side effects of chemotherapy agents may also contribute to the significantly shorter RFS in the NACT group\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the present study, certain limitations should be acknowledged. First of all, this study was conducted in Chinese individuals, so conclusions cannot be simply applied to populations with different racial backgrounds. Although the dataset was sufficiently robust to enhance the reliability of our findings, the single-center design and retrospective methodology may have introduced both selection and information biases.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, while our study identified differences in certain complications between the two groups, NACT is not an independent influencing factor. To mitigate patient discomfort and prevent potential complications, surgeons should prudently use antibiotics and consider factors such as age, BMI, and underlying health conditions like diabetes when developing appropriate treatment plans.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinicopathological data underpinning the findings of this study are accessible in the Figshare repository: https://doi.org/10.6084/m9.figshare.28090466.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were conducted in accordance with applicable institutional and national guidelines. Ethical approval for this study was granted by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (Approval No. 2020-202).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was waived due to the retrospective design of the study. All patient data were handled with strict confidentiality, and all procedures were conducted in accordance with the requirements of the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their sincere gratitude to all study participants, research personnel, and students whose contributions were essential to the completion of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, Lingfeng Tang and Shengchun Liu; Data curation, Chi Zhang, Hailin Yang, Zheng Zou; Formal analysis, Chi Zhang, Hailin Yang, Zheng Zou; Investigation, Lingfeng Tang, JiHan Qiu ; Methodology, Lingfeng Tang, Haochen Yu and Shengchun Liu; Resources, Lingfeng Tang, Hailin Yang and Zheng Zou; Software, Hanzhi Li and Haochen Yu; Supervision, Lingfeng Tang and Shengchun Liu; Writing-original draft, Lingfeng Tang, Chi Zhang and Hailin Yang; Writing-review \u0026amp; editing, Lingfeng Tang and Zheng Zou.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Key Research and Development Project of Chongqing\u0026rsquo;s Technology Innovation and Application Development Special Program in the Field of Big Health (Project Approval Number: CSTC2021jscx-gksb-N0027).\u003c/p\u003e\n\u003cp\u003eThe First Clinical College Clinical medicine first-class discipline construction project to department of Breast and Thyroid Surgery (CYYY-BSYJSCXXW-202322).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilkinson L, Gathani T. Understanding breast cancer as a global health concern. Br J Radiol. 2022;95(1130):20211033.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSancho-Garnier H, Colonna M. [Breast cancer epidemiology]. Presse Med. 2019;48(10):1076\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeng Y, Spezia M, Huang S, et al. Breast cancer development and progression: Risk factors, cancer stem cells, signaling pathways, genomics, and molecular pathogenesis. Genes Dis. 2018;5(2):77\u0026ndash;106.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimion L, Rotaru V, Cirimbei C et al. Inequities in Screening and HPV Vaccination Programs and Their Impact on Cervical Cancer Statistics in Romania. Diagnostics (Basel) 2023; 13(17).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimion L, Chitoran E, Cirimbei C et al. A Decade of Therapeutic Challenges in Synchronous Gynecological Cancers from the Bucharest Oncological Institute. Diagnostics (Basel) 2023; 13(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMieog JS, van der Hage JA, van de Velde CJ. Preoperative chemotherapy for women with operable breast cancer. \u003cem\u003eCochrane Database Syst Rev\u003c/em\u003e 2007; 2007(2):CD005002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAngelos P, Bedrosian I, Euhus DM, et al. Contralateral Prophylactic Mastectomy: Challenging Considerations for the Surgeon. Ann Surg Oncol. 2015;22(10):3208\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong J, Zhang X, Liu Q, et al. Impact of neoadjuvant chemotherapy on immediate breast reconstruction: a meta-analysis. PLoS ONE. 2014;9(5):e98225.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32(9):919\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBagnyukova TV, Serebriiskii IG, Zhou Y, et al. Chemotherapy and signaling: How can targeted therapies supercharge cytotoxic agents? Cancer Biol Ther. 2010;10(9):839\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBracci L, Schiavoni G, Sistigu A, et al. Immune-based mechanisms of cytotoxic chemotherapy: implications for the design of novel and rationale-based combined treatments against cancer. Cell Death Differ. 2014;21(1):15\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOhmoto A, Fuji S. Infection profiles of different chemotherapy regimens and the clinical feasibility of antimicrobial prophylaxis in patients with DLBCL. Blood Rev. 2021;46:100738.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranz MG, Steed DL, Robson MC. Optimizing healing of the acute wound by minimizing complications. Curr Probl Surg. 2007;44(11):691\u0026ndash;763.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo S, Dipietro LA. Factors affecting wound healing. J Dent Res. 2010;89(3):219\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsif HM, Sultana S, Ahmed S, et al. HER-2 Positive Breast Cancer - a Mini-Review. Asian Pac J Cancer Prev. 2016;17(4):1609\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang A, Wang X, Fan C, et al. The Role of Ki67 in Evaluating Neoadjuvant Endocrine Therapy of Hormone Receptor-Positive Breast Cancer. Front Endocrinol (Lausanne). 2021;12:687244.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTse T, Sehdev S, Seely J, et al. Neoadjuvant Chemotherapy in Breast Cancer: Review of the Evidence and Conditions That Facilitated Its Use during the Global Pandemic. Curr Oncol. 2021;28(2):1338\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThompson JA, Schneider BJ, Brahmer J, et al. Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(4):387\u0026ndash;405.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHart SE, Brown DL, Kim HM, et al. Association of Clinical Complications of Chemotherapy and Patient-Reported Outcomes After Immediate Breast Reconstruction. JAMA Surg. 2021;156(9):847\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDecker MR, Greenblatt DY, Havlena J, et al. Impact of neoadjuvant chemotherapy on wound complications after breast surgery. Surgery. 2012;152(3):382\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitchem J, Herrmann D, Margenthaler JA, et al. Impact of neoadjuvant chemotherapy on rate of tissue expander/implant loss and progression to successful breast reconstruction following mastectomy. Am J Surg. 2008;196(4):519\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGralow JR, Burstein HJ, Wood W, et al. Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. J Clin Oncol. 2008;26(5):814\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoeste MR, Bhutiani N, Donaldson M, et al. Evaluating the effect of neoadjuvant chemotherapy on surgical outcomes after breast conserving surgery. J Surg Oncol. 2021;123(2):439\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLawrence WT, Talbot TL, Norton JA. Preoperative or postoperative doxorubicin hydrochloride (adriamycin): which is better for wound healing? Surgery. 1986;100(1):9\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDevereux DF, Thibault L, Boretos J, et al. The quantitative and qualitative impairment of wound healing by adriamycin. Cancer. 1979;43(3):932\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandoo A, Kitas GD, Carmichael AR. Endothelial dysfunction as a determinant of trastuzumab-mediated cardiotoxicity in patients with breast cancer. Anticancer Res. 2014;34(3):1147\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuerer HM, Hunt KK, Newman LA, et al. Neoadjuvant chemotherapy in women with invasive breast carcinoma: conceptual basis and fundamental surgical issues. J Am Coll Surg. 2000;190(3):350\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu YY, Weeks CM, In H, et al. Impact of neoadjuvant chemotherapy on breast reconstruction. Cancer. 2011;117(13):2833\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVarghese J, Gohari SS, Rizki H, et al. A systematic review and meta-analysis on the effect of neoadjuvant chemotherapy on complications following immediate breast reconstruction. Breast. 2021;55:55\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSabitovic A, Trostrup H, Damsgaard TE. The impact of neoadjuvant chemotherapy on surgical outcomes following autologous and implant-based immediate breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2023;87:17\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehrara BJ, Santoro TD, Arcilla E, et al. Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg. 2006;118(5):1100\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDolen UC, Schmidt AC, Um GT, et al. Impact of Neoadjuvant and Adjuvant Chemotherapy on Immediate Tissue Expander Breast Reconstruction. Ann Surg Oncol. 2016;23(7):2357\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorentzen T, Heidemann LN, Moller S, et al. Impact of neoadjuvant chemotherapy on surgical complications in breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2022;48(1):44\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeugels J, Meijvogel JLW, Tuinder SMH, et al. The influence of neoadjuvant chemotherapy on complications of immediate DIEP flap breast reconstructions. Breast Cancer Res Treat. 2019;176(2):367\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakchoul T, Marini I. Drug-associated thrombocytopenia. \u003cem\u003eHematology Am Soc Hematol Educ Program\u003c/em\u003e 2018; 2018(1):576\u0026ndash;583.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazzam ME, Ng P. Postoperative Seroma Management. In: 37, ed. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Paul Ng declares no relevant financial relationships with ineligible companies.; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzzawi K, Ismail A, Earl H, et al. Influence of neoadjuvant chemotherapy on outcomes of immediate breast reconstruction. Plast Reconstr Surg. 2010;126(1):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMajor Extremity Trauma Research C, O'Toole RV, Joshi M, et al. Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial. JAMA Surg. 2021;156(5):e207259.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNag S, Berlin L, Hunter K, et al. Effects of Neoadjuvant Chemotherapy on Autologous and Implant-Based Breast Reconstruction: A Systematic Review and Meta-Analysis of the Literature. Clin Breast Cancer. 2024;24(3):184\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarson CC. Diagnosis, treatment and prevention of penile prosthesis infection. Int J Impot Res. 2003;15(Suppl 5):S139\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurphy BD, Kerrebijn I, Farhadi J, et al. Indications and Controversies for Abdominally-Based Complete Autologous Tissue Breast Reconstruction. Clin Plast Surg. 2018;45(1):83\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllue Cabanuz M, Del Arribas MD, Gil Romea I, et al. Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: A safe option? Cir Esp (Engl Ed). 2019;97(10):575\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018;34(5):575\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarren Peled A, Itakura K, Foster RD, et al. Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction. Arch Surg. 2010;145(9):880\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJimenez-Puente A, Prieto-Lara E, Rueda-Dominguez A, et al. Complications in immediate breast reconstruction after mastectomy. Int J Technol Assess Health Care. 2011;27(4):298\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarazzuol L, Coppes RP, van Luijk P. Prevention and treatment of radiotherapy-induced side effects. Mol Oncol. 2020;14(7):1538\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen Z, Sun J, Yu Y, et al. Oncological safety and complication risks of mastectomy with or without breast reconstruction: A Bayesian analysis. J Plast Reconstr Aesthet Surg. 2021;74(2):290\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Neoadjuvant chemotherapy, Implant-based Breast Reconstruction, Complication","lastPublishedDoi":"10.21203/rs.3.rs-8212590/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8212590/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCurrently, the use of neoadjuvant chemotherapy (NACT) and implant-based breast reconstruction (IBR) is becoming increasingly prevalent in clinical practice. This investigation sought to determine the impact of NACT on outcomes connected to IBR.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe analyzed the medical records of patients who underwent IBR at the First Affiliated Hospital of Chongqing Medical University during the period from January 1, 2008, to December 31, 2019.A total of 562 patients were enrolled, including 233 who received NACT and 329 who did not receive NACT. We evaluated complications and identified influencing factors. Patient satisfaction with reconstruction surgery was assessed using the BREAST-Q score. In the end, we assessed the patients' 5-year disease-free survival (DFS) rates.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn baseline observations, we found statistically significant differences in age (P\u0026thinsp;=\u0026thinsp;0.027), N stage (P\u0026thinsp;=\u0026thinsp;0.037), histological grade (P\u0026thinsp;=\u0026thinsp;0.001), Ki-67 expression (P\u0026thinsp;=\u0026thinsp;0.011), and reconstruction mode (P\u0026thinsp;=\u0026thinsp;0.002). There were also significant differences in the occurrence of seromas (P\u0026thinsp;=\u0026thinsp;0.017) and skin-flap necrosis (P\u0026thinsp;=\u0026thinsp;0.034) between the two groups of patients. T stage (P\u0026thinsp;=\u0026thinsp;0.019) and diabetes (P\u0026thinsp;=\u0026thinsp;0.001) were identified as independent influencing factors for total complications, while NACT was not. Between the non-NACT group and the NACT group, a significant difference in 5-year DFS was noted, with rates of 92.46% and 87.12%, respectively (P\u0026thinsp;=\u0026thinsp;0.020).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOur research indicates that NACT is not an independent factor affecting common complications and does not influence patient satisfaction after IBR surgery. However, in clinical practice, individualized treatment plans should be formulated based on factors such as tumor size, age, diabetes history, and other relevant considerations to minimize the occurrence of complications.\u003c/p\u003e","manuscriptTitle":"Implant-Based Breast Reconstruction: A Single-Center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 08:52:34","doi":"10.21203/rs.3.rs-8212590/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-03T11:16:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-30T16:12:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-10T06:42:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3515660479316498127990749035618752715","date":"2026-01-05T08:26:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146129560526765433987769212018575302021","date":"2026-01-05T05:06:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49872025640689578196424033472447955456","date":"2025-12-15T23:51:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-12T02:33:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-01T11:53:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-01T11:51:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-11-26T11:39:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af7938c2-426b-4c25-a040-6292eafac3b1","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T12:53:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 08:52:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8212590","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8212590","identity":"rs-8212590","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}