Background: Implant-based breast reconstruction (IBBR) is a widely adopted technique following mastectomy in breast cancer patients. However, the impact of chemotherapy type and duration on the development of capsular contracture remains unclear. Methods: This nationwide, retrospective, cohort study used Health Insurance Review and Assessment Service data to identify breast cancer patients who received chemotherapy and underwent immediate IBBR between January 2015 and December 2018. Follow-up continued until January 2024, with a median follow-up of 5.2 years. A total of 4303 patients (direct-to-implant [DTI], n = 2083; tissue expander insertion [TEI], n = 2220) were included. Results: Chemotherapy type and duration were not significantly associated with capsular contracture risk in either the DTI or TEI groups. In the DTI cohort, no significant difference in contracture incidence was found between neoadjuvant and adjuvant chemotherapy before or after matching (p= 0.056 andp= 0.121, respectively). In the TEI cohort, an initially significant difference (p= 0.019) was no longer observed after matching (p= 0.213). Similarly, chemotherapy duration (≤12 weeks vs. >12 weeks) did not impact contracture risk in either cohort. Multivariate analysis identified age, radiotherapy, lymphedema, and axillary lymph node dissection (ALND) as independent risk factors for contracture (p< 0.005). Comorbidities, such as diabetes and autoimmune diseases, also showed no significant association with contracture risk. Conclusions: These findings suggest that chemotherapy decisions should not be guided by contracture concerns. Instead, optimizing reconstruction outcomes should focus on modifiable factors, such as radiotherapy, lymphedema, and ALND.
背景：基于植入物的乳房重建术是乳腺癌患者乳房切除术后广泛采用的技术。然而，化疗类型和持续时间对包膜挛缩发生的影响尚不明确。方法：这项全国性回顾性队列研究利用健康保险审查与评估服务数据，识别了2015年1月至2018年12月期间接受化疗并同期进行植入物乳房重建术的乳腺癌患者。随访持续至2024年1月，中位随访时间为5.2年。共纳入4303例患者（直接植入组2083例；组织扩张器植入组2220例）。结果：在直接植入组和组织扩张器植入组中，化疗类型和持续时间均与包膜挛缩风险无显著相关性。在直接植入队列中，匹配前后新辅助化疗与辅助化疗的挛缩发生率均无显著差异（p值分别为0.056和0.121）。在组织扩张器植入队列中，匹配前观察到的显著差异（p=0.019）在匹配后不再显现（p=0.213）。同样，化疗持续时间（≤12周 vs. >12周）对两个队列的挛缩风险均无影响。多变量分析确定年龄、放疗、淋巴水肿和腋窝淋巴结清扫是包膜挛缩的独立危险因素（p<0.005）。糖尿病和自身免疫性疾病等合并症也与挛缩风险无显著关联。结论：这些研究结果表明，化疗决策不应以包膜挛缩风险为考量依据。优化重建效果应重点关注可调控因素，如放疗、淋巴水肿和腋窝淋巴结清扫。
肿瘤(癌症)患者之家