title: Pre-operative thrombotic complications of neoadjuvant chemotherapy for breast cancer: Implications for immediate breast reconstruction.
abstract: Thrombotic complications arising during the treatment of breast cancer can impact the breast reconstruction pathway. We set out to review the details of cases of thromboembolism occurring during neoadjuvant chemotherapy and peri-operatively to study the impact of the event and its management on subsequent breast reconstruction.
  
  
  METHODS
  We retrospectively reviewed the medical records of seven patients who had experienced a thrombotic event during their treatment of breast cancer between 2008 and 2012, who then proceeded to breast reconstruction. We recorded size and grade of tumour, neoadjuvant chemotherapeutic regimen, details of port insertion, planned reconstruction, thrombotic event and its management and the surgery performed and outcome.
  
  
  RESULTS
  All patients received chemotherapy via central venous access and went on to present with local symptomatic thrombosis. They were managed with anticoagulant regimens at the time of mastectomy and reconstruction, which were unique for each patient. The results revealed delays to surgery and modifications to planned reconstruction.
  
  
  CONCLUSIONS
  The majority of patients developing thrombotic complications go on to achieve successful reconstruction. There is significant variation in the anticoagulation management in this patient group. Identification of optimal anticoagulant regimes and the possibilities for prophylaxis may prove key in informing surgeons when planning the reconstructive process.
  
  
  CONCLUSIONS
  An awareness of the effects of thrombotic events in this patient group is important in terms of developing an understanding of its impact on the performance of reconstruction, on the management of anticoagulation peri-operatively and on monitoring for post-operative complications.
authors.affiliation: Clinical School of Medicine, Cambridge University, UK.
authors.forename: K
authors.initials: K
authors.lastname: Richards
authors.affiliation: Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: P
authors.initials: P
authors.lastname: Forouhi
authors.affiliation: Department of Anaesthesia and ICU, Cambridge University Hospitals NHS Foundation Trust, UK.
authors.forename: A
authors.initials: A
authors.lastname: Johnston
authors.affiliation: Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK ; Plastic & Reconstructive Surgery Depatment, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK ; Postgraduate Medical Institute at Anglia Ruskin University, Cambridge, Chelmsford, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Malata
keywords: Breast expander-implant; DIEP flap; Immediate breast reconstruction; Neoadjuvant chemotherapy; Pulmonary embolism; Venous thrombosis
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