title: Immediate free flap reconstruction for advanced-stage breast cancer: is it safe?
abstract: BACKGROUND
  Numerous studies have demonstrated that immediate breast reconstruction following mastectomy is associated with improvements in quality of life and body image. However, immediate breast reconstruction for advanced-stage breast cancer remains controversial. This study evaluates its safety in patients with advanced-stage breast cancer.
  
  
  METHODS
  Over a 10-year period, patients diagnosed with stage IIB or greater breast cancer treated with mastectomy followed by immediate breast reconstruction were identified and analyzed. Complication rates and reconstructive aesthetics were determined.
  
  
  RESULTS
  One hundred seventy patients were identified who underwent 157 unilateral and 13 bilateral reconstructions (183 flaps) predominantly by means of free transverse rectus abdominis musculocutaneous flaps (n = 162). The average age was 47 years and the average hospital stay was 5.1 days. There were 15 major complications (8.8 percent), but adjuvant postoperative therapy was delayed in only eight patients (4.7 percent), with the maximum delay lasting 3 weeks in one patient. Although some degree of flap shrinkage was noted in 30 percent of patients treated with postoperative radiotherapy, only 10 percent of patients experienced severe breast distortion. Importantly, the overall cosmetic outcome in patients who underwent postoperative irradiation was comparable to that of those who did not.
  
  
  CONCLUSIONS
  The authors have shown that immediate breast reconstruction in the setting of advanced-stage breast cancer is safe and well tolerated by patients, and is not associated with significant delays in adjuvant therapy. These findings make a strong argument for immediate reconstruction regardless of cancer stage. The authors found the changes caused by radiation to the reconstructed breast to be less significant than previously reported and readily addressed to complete an ultimate reconstruction that is aesthetically acceptable to both surgeon and patient.
  
  
  METHODS
  Therapeutic, IV.(Figure is included in full-text article.).
authors.affiliation: Los Angeles, Calif.; and New York, N.Y. From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles Medical Center, and the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Crisera
authors.forename: Eric I
authors.initials: EI
authors.lastname: Chang
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Da Lio
authors.forename: Jaco H
authors.initials: JH
authors.lastname: Festekjian
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D055815:Young Adult