title: Immediate microvascular breast reconstruction after neoadjuvant chemotherapy: complication rates and effect on start of adjuvant treatment.
abstract: BACKGROUND
  The effect of neoadjuvant chemotherapy on immediate microvascular breast reconstruction is of concern because any complication might delay adjuvant treatment. We sought to determine whether the complication rate is increased and whether the interval between surgery and subsequent treatment is delayed compared with patients without neoadjuvant chemotherapy.
  
  
  METHODS
  Complication rates and interval from surgery until adjuvant treatment of patients with mastectomy for locally advanced breast cancer followed by immediate microvascular breast reconstruction (deep inferior epigastric perforator (DIEP) flap, transverse rectus abdominis musculocutaneous (TRAM) flap, superior gluteal artery perforator (SGAP) flap, transverse musculocutaneous gracilis (TMG) flap, or superficial inferior epigastric artery (SIEA) flap) after neoadjuvant chemotherapy were compared with those of patients who underwent immediate breast reconstruction without neoadjuvant chemotherapy.
  
  
  RESULTS
  Forty-seven patients with locally advanced breast cancers who underwent neoadjuvant chemotherapy before mastectomy and immediate microvascular reconstruction and 52 patients without neoadjuvant chemotherapy were identified. 36% of patients with neoadjuvant chemotherapy had one or more complications compared with 29% of patients without previous chemotherapy, but this difference was not statistically significant. The occurrence of complications in patients with neoadjuvant chemotherapy did not result in a delayed start of adjuvant treatment compared with patients without complications after neoadjuvant chemotherapy (43.6 vs. 44.6 days).
  
  
  CONCLUSIONS
  Immediate microvascular breast reconstruction after neoadjuvant chemotherapy does not result in an increased complication rate or delay the start of adjuvant treatment even if complications occur and therefore can be performed safely in patients with locally advanced breast cancer.
authors.affiliation: Department of Plastic Surgery, Guy's and St. Thomas' Hospital, London, UK. mzweifel@uhbs.ch
authors.forename: Mirjam
authors.initials: M
authors.lastname: Zweifel-Schlatter
authors.forename: Nagham
authors.initials: N
authors.lastname: Darhouse
authors.forename: Paul
authors.initials: P
authors.lastname: Roblin
authors.forename: David
authors.initials: D
authors.lastname: Ross
authors.forename: Martin
authors.initials: M
authors.lastname: Zweifel
authors.forename: Jian
authors.initials: J
authors.lastname: Farhadi
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001940:Breast / Q000601:surgery; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D013524:Surgical Flaps / Q000098:blood supply; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents