title: Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction.
abstract: OBJECTIVE
  To determine the impact of chemotherapy and the timing of chemotherapy on postoperative outcomes after mastectomy and immediate breast reconstruction.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  University tertiary care institution.
  
  
  METHODS
  One hundred sixty-three consecutive patients undergoing mastectomy and immediate breast reconstruction.
  
  
  METHODS
  Systemic chemotherapy for breast cancer.
  
  
  METHODS
  Postoperative complications following mastectomy and immediate breast reconstruction.
  
  
  RESULTS
  One hundred sixty-three patients underwent mastectomy and immediate breast reconstruction during the study period, with a mean postoperative follow-up of 19.2 months. Sixty-six percent of the patients had expander/implant reconstruction, while 33% underwent autologous reconstruction. Fifty-seven patients received neoadjuvant chemotherapy and 41 received postoperative chemotherapy. Eighteen patients (44%) in the adjuvant chemotherapy cohort developed postoperative infections, compared with 13 patients (23%) in the neoadjuvant chemotherapy group and 16 patients (25%) who did not receive any chemotherapy (P = .05). Overall, 31% of patients had a complication requiring an unplanned return to the operating room; this rate did not differ between groups (P = .79). Of patients who underwent expander/implant reconstruction, 8 women (26%) in the neoadjuvant chemotherapy cohort, 7 women (22%) in the adjuvant chemotherapy cohort, and 8 women (18%) without chemotherapy required expander or implant removal (P = .70).
  
  
  CONCLUSIONS
  Although the highest rate of surgical site infections was in the adjuvant chemotherapy group, there were no differences between groups with respect to unplanned return to the operating room, expander loss, and donor-site complications. Neither the inclusion of chemotherapy nor the timing of its administration significantly affected the complication rates after mastectomy and immediate breast reconstruction in this population.
authors.affiliation: Division of Breast Surgery, Department of Surgery, University of California-San Francisco, 1600 Divisadero Street, San Francisco, CA 94115, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Warren Peled
authors.forename: Kaoru
authors.initials: K
authors.lastname: Itakura
authors.forename: Robert D
authors.initials: RD
authors.lastname: Foster
authors.forename: Debby
authors.initials: D
authors.lastname: Hamolsky
authors.forename: Janet
authors.initials: J
authors.lastname: Tanaka
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ewing
authors.forename: Michael
authors.initials: M
authors.lastname: Alvarado
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
authors.forename: E Shelley
authors.initials: ES
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D019928:Breast Implantation; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012086:Reoperation / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000453:epidemiology*; D015625:Tissue Expansion Devices; D014945:Wound Healing / Q000187:drug effects