title: Outcomes of immediate perforator flap reconstruction after skin-sparing mastectomy following neoadjuvant chemotherapy.
abstract: BACKGROUND
  The impact of neoadjuvant chemotherapy (NACT) on immediate free flap breast reconstruction remains controversial. Furthermore, the oncological outcomes of immediate free flap breast reconstruction after skin-sparing mastectomy (SSM) following NACT remain unclear. This study aimed to investigate the surgical complications and oncological outcomes of immediate perforator flap reconstruction after SSM following NACT.
  
  
  METHODS
  A total of 201 consecutive patients with indications for immediate perforator flap reconstruction after SSM were included between 2004 and 2012. Surgical and oncological outcomes were compared between patients with and without NACT.
  
  
  RESULTS
  There were 38 patients in the NACT group and 163 in the non-NACT control group. The median age of the NACT group was 39.5 years, which was significantly younger than the control group (43.0 years; P < 0.05). Patients in the NACT group also had more advanced and aggressive disease (P < 0.05). There was no significant difference in the frequency of surgical complications between the groups, no difference in the type of complications, and no significant difference in the frequencies of major and minor complications. No patients in the NACT group had delayed adjuvant therapy. Eight patients (4%) developed recurrences, with a median follow-up time of 3.0 years. Local recurrences occurred in three control patients but no patients in the NACT group.
  
  
  CONCLUSIONS
  NACT does not affect short-term or interim outcomes after immediate perforator flap reconstruction and may thus represent a safe and practical treatment option for the multidisciplinary treatment of breast cancer.
authors.affiliation: Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. Electronic address: nr1@gc5.so-net.ne.jp.
authors.forename: K
authors.initials: K
authors.lastname: Narui
authors.affiliation: Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Plastic Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Satake
authors.affiliation: Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Adachi
authors.affiliation: Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Yamada
authors.affiliation: Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
authors.forename: D
authors.initials: D
authors.lastname: Shimizu
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kida
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Sugae
authors.affiliation: Department of Clinical Oncology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ichikawa
authors.affiliation: Department of Pathology, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tanabe
authors.affiliation: Department of Pathology, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Endo
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery*; D016190:Carboplatin / Q000627:therapeutic use; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D000077143:Docetaxel; D015251:Epirubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D017239:Paclitaxel / Q000008:administration & dosage; D061525:Perforator Flap; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage; D000068878:Trastuzumab; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D043823:Taxoids; D000077143:Docetaxel; D015251:Epirubicin; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin; D000068878:Trastuzumab; D017239:Paclitaxel; D005472:Fluorouracil
keywords: Breast cancer; Immediate reconstruction; Neoadjuvant chemotherapy; Perforator flap