title: Immediate reconstruction after neoadjuvant chemotherapy: effect on adjuvant treatment starting and survival.
abstract: BACKGROUND
  For patients treated with initial surgery, the safety of immediate breast reconstruction after mastectomy has been demonstrated. Some concerns exist after neoadjuvant chemotherapy because this sequence is proposed for patients with large tumors and for whom adjuvant therapies are considered cornerstones of treatment. In this study, we sought to determine whether reconstruction after neoadjuvant chemotherapy and mastectomy for large operable breast cancer affects the interval between surgery and adjuvant treatment and affects survival.
  
  
  METHODS
  A single-institution retrospective analysis was performed by using the database of the Institut Gustave-Roussy.
  
  
  RESULTS
  Forty-eight patients who had undergone mastectomy and immediate reconstruction (implant, 60%) followed by adjuvant chemotherapy were identified. They were compared with 181 patients who underwent mastectomy without reconstruction and with 32 patients who underwent mastectomy followed by delayed reconstruction (implant, 19%). No difference was found concerning the interval between surgery and adjuvant chemotherapy: 26 vs. 23 days for patients with immediate breast reconstruction and for patients treated with modified radical mastectomy followed or not by delayed reconstruction, respectively (P = .11). No difference was found concerning the onset of radiotherapy: 87 vs. 81 days (P = .22). Survival was not different in patients treated with immediate reconstruction compared with those with mastectomy alone.
  
  
  CONCLUSIONS
  Immediate breast reconstruction does not delay the starting of adjuvant therapy and has no significant effect on local relapse-free or distant disease-free survival. Additional data are needed concerning the use of flap for this indication.
authors.affiliation: Breast Surgery Unit, Institut Gustave-Roussy, 39 Rue C. Desmoulins, 94805 Villejuif Cedex, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gouy
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Missana
authors.forename: David
authors.initials: D
authors.lastname: Atallah
authors.forename: Omar
authors.initials: O
authors.lastname: Youssef
authors.forename: Lise
authors.initials: L
authors.lastname: Barreau-Pouhaer
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000628:therapy*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents