Effect of neoadjuvant chemotherapy on outcomes of immediate free autologous breast reconstruction

Neoadjuvant chemotherapy (NC) is increasingly being utilised although the effects on outcomes of free autologous breast reconstruction and adjuvant treatment remain unclear. The aim of this study was to examine the effect of NC on complications following immediate free flap breast reconstruction.

A prospective study of immediate free flap breast reconstructions comparing patients who received NC with those who did not was conducted in a single specialist regional unit.

Eighty-seven patients (95 flaps) were included in the study, 30 of which (35 flaps) received NC followed by free flap breast reconstruction. Twenty patients in the NC group had one or more complications compared with 37 patients in the control group (p = 0.87). Nine patients in the NC group had more than one complication compared with 11 patients in the control group, although this difference was not significant (p = 0.26). Both obesity (p = 0.016) and current cigarette smoking (p = 0.014) were significantly associated with the occurrence of any complication in patients who had received NC. Adjuvant radiotherapy was delayed in 3 patients in the NC group, and adjuvant chemotherapy was delayed in 3 control patients (p = 1). The mean preoperative haemoglobin was significantly lower in the NC group than in the control group (p = 0.00037), although there was no significant difference in blood transfusion requirements.

Patients undergoing immediate autologous breast reconstruction following NC have a similar complication and reoperation rate to patients not receiving NC. Preoperative blood haemoglobin level was found to be significantly lower following NC and postoperative blood transfusion triggers should take this into account.