Immediate Microvascular Breast Reconstruction After Neoadjuvant Chemotherapy: Complication Rates and Effect on Start of Adjuvant Treatment

Background The effect of neoadjuvant chemotherapy on immediate microvascular breast reconstruction is of concern because any complication might delay adjuvant treatment. We sought to determine whether the complication rate is increased and whether the interval between surgery and subsequent treatment is delayed compared with patients without neoadjuvant chemotherapy. Methods Complication rates and interval from surgery until adjuvant treatment of patients with mastectomy for locally advanced breast cancer followed by immediate microvascular breast reconstruction (deep inferior epigastric perforator (DIEP) flap, transverse rectus abdominis musculocutaneous (TRAM) flap, superior gluteal artery perforator (SGAP) flap, transverse musculocutaneous gracilis (TMG) flap, or superficial inferior epigastric artery (SIEA) flap) after neoadjuvant chemotherapy were compared with those of patients who underwent immediate breast reconstruction without neoadjuvant chemotherapy. Results Forty-seven patients with locally advanced breast cancers who underwent neoadjuvant chemotherapy before mastectomy and immediate microvascular reconstruction and 52 patients without neoadjuvant chemotherapy were identified. 36% of patients with neoadjuvant chemotherapy had one or more complications compared with 29% of patients without previous chemotherapy, but this difference was not statistically significant. The occurrence of complications in patients with neoadjuvant chemotherapy did not result in a delayed start of adjuvant treatment compared with patients without complications after neoadjuvant chemotherapy (43.6 vs. 44.6 days). Conclusions Immediate microvascular breast reconstruction after neoadjuvant chemotherapy does not result in an increased complication rate or delay the start of adjuvant treatment even if complications occur and therefore can be performed safely in patients with locally advanced breast cancer.