title: Adjuvant chemotherapy increases the prevalence of fat necrosis in immediate free abdominal flap breast reconstruction.
abstract: BACKGROUND
  Fat necrosis is one of the most common complications following free flap breast reconstruction. Although a minor complication, fat necrosis can compromise esthetic results and confuse with cancer recurrence. Perfusion-related factors and post-operative radiotherapy are the known risks. However, the influence of adjuvant chemotherapy on fat necrosis prevalence remains unknown.
  
  
  METHODS
  Our initial experience of 88 consecutive breast reconstructions with free abdominal flaps was reviewed. The prevalence of fat necrosis was recorded and the risk factors were analyzed using univariate and multivariate logistic regression models.
  
  
  RESULTS
  The overall prevalence of fat necrosis was 36.4% in this series. In a multivariate logistic regression model, adjuvant chemotherapy significantly increased the risk of fat necrosis. The relative risk was 4.762 (95% confidence interval (CI), 1.767-12.831; p = 0.002). There was no evidence of a specific chemotherapeutic agent causing fat necrosis. The first cycle of adjuvant chemotherapy was frequently delivered earlier in patients with fat necrosis than those without fat necrosis, although this tendency was not statistically significant.
  
  
  CONCLUSIONS
  Our initial experience with free flap breast reconstruction seems to suggest that chemotherapy may increase the risk of fat necrosis following immediate breast reconstruction. Patients should be fully informed, and the initiation of post-operative chemotherapy may be adjusted accordingly.
authors: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Lin
authors: L
authors: Li
authors: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Ying
authors: Y
authors: Chen
authors: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Jiaying
authors: J
authors: Chen
authors: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Jiajian
authors: J
authors: Chen
authors: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Benlong
authors: B
authors: Yang
authors: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Junjie
authors: J
authors: Li
authors: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Xiaoyan
authors: X
authors: Huang
authors: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Zhenzhou
authors: Z
authors: Shen
authors: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Zhimin
authors: Z
authors: Shao
authors: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Peirong
authors: P
authors: Yu
authors: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. Electronic address: wujiong1122@vip.sina.com.
authors: Jiong
authors: J
authors: Wu
mesh_terms: D000009:Abdominal Muscles / Q000637:transplantation*; D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001940:Breast / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D005218:Fat Necrosis / Q000139:chemically induced* / Q000209:etiology; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects* / Q000098:blood supply / Q000473:pathology; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents
keywords: Adjuvant chemotherapy; Breast reconstruction; Fat necrosis; Free tissue flap; Microsurgery; Post-operative complications; Risk factors