Annals of Surgical Oncology

, Volume 12, Issue 2, pp 161–166 | Cite as

Immediate Reconstruction After Neoadjuvant Chemotherapy: Effect on Adjuvant Treatment Starting and Survival

  • Sebastien Gouy
  • Roman Rouzier
  • Marie-Christine Missana
  • David Atallah
  • Omar Youssef
  • Lise Barreau-Pouhaer



For patients treated with initial surgery, the safety of immediate breast reconstruction after mastectomy has been demonstrated. Some concerns exist after neoadjuvant chemotherapy because this sequence is proposed for patients with large tumors and for whom adjuvant therapies are considered cornerstones of treatment. In this study, we sought to determine whether reconstruction after neoadjuvant chemotherapy and mastectomy for large operable breast cancer affects the interval between surgery and adjuvant treatment and affects survival.


A single-institution retrospective analysis was performed by using the database of the Institut Gustave-Roussy.


Forty-eight patients who had undergone mastectomy and immediate reconstruction (implant, 60%) followed by adjuvant chemotherapy were identified. They were compared with 181 patients who underwent mastectomy without reconstruction and with 32 patients who underwent mastectomy followed by delayed reconstruction (implant, 19%). No difference was found concerning the interval between surgery and adjuvant chemotherapy: 26 vs. 23 days for patients with immediate breast reconstruction and for patients treated with modified radical mastectomy followed or not by delayed reconstruction, respectively (P = .11). No difference was found concerning the onset of radiotherapy: 87 vs. 81 days (P = .22). Survival was not different in patients treated with immediate reconstruction compared with those with mastectomy alone.


Immediate breast reconstruction does not delay the starting of adjuvant therapy and has no significant effect on local relapse–free or distant disease–free survival. Additional data are needed concerning the use of flap for this indication.


Breast cancer Neoadjuvant chemotherapy Immediate reconstruction Survival 



Supported by the Association pour la Recherche sur le Cancer (RR).


  1. 1.
    Smith, IE, Lipton, L 2001Preoperative/neoadjuvant medical therapy for early breast cancerLancet Oncol256170PubMedGoogle Scholar
  2. 2.
    Rouzier, R, Extra, JM, Carton, M,  et al. 2001Primary chemotherapy for operable breast cancer: incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgeryJ Clin Oncol19382835PubMedGoogle Scholar
  3. 3.
    Buchholz, TA, Kronowitz, SJ, Kuerer, HM 2002Immediate breast reconstruction after skin-sparing mastectomy for the treatment of advanced breast cancer: radiation oncology considerationsAnn Surg Oncol98201PubMedGoogle Scholar
  4. 4.
    Schwartz, GF, Hortobagyi, GN 2004Proceedings of the consensus conference on neoadjuvant chemotherapy in carcinoma of the breast, April 26-28, 2003, Philadelphia, PennsylvaniaCancer100251232PubMedGoogle Scholar
  5. 5.
    Spear, SL, Baker, JL,Jr. 1995Classification of capsular contracture after prosthetic breast reconstructionPlast Reconstr Surg96111923discussion 1124CrossRefPubMedGoogle Scholar
  6. 6.
    Alderman, AK, McMahon, L,Jr, Wilkins, EG 2003The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factorsPlast Reconstr Surg111695703discussion 704–5PubMedGoogle Scholar
  7. 7.
    Polednak, AP 2001How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databasesPlast Reconstr Surg108737PubMedGoogle Scholar
  8. 8.
    Spyrou, GE, Titley, OG, Cerqueiro, J, Fatah, MF 1998A survey of general surgeons’ attitudes towards breast reconstruction after mastectomyAnn R Coll Surg Engl8017883PubMedGoogle Scholar
  9. 9.
    Schain, WS, Wellisch, DK, Pasnau, RO, Landsverk, J 1985The sooner the better: a study of psychological factors in women undergoing immediate versus delayed breast reconstructionAm J Psychiatry142406PubMedGoogle Scholar
  10. 10.
    DeBono, R, Thompson, A, Stevenson, JH 2002Immediate versus delayed free TRAM breast reconstruction: an analysis of perioperative factors and complicationsBr J Plast Surg551116PubMedGoogle Scholar
  11. 11.
    Morrow, M, Scott, SK, Menck, HR, Mustoe, TA, Winchester, DP 2001Factors influencing the use of breast reconstruction postmastectomy: a National Cancer Database studyJ Am Coll Surg19218PubMedGoogle Scholar
  12. 12.
    Reaby, LL 1998Reasons why women who have mastectomy decide to have or not to have breast reconstructionPlast Reconstr Surg10118108PubMedGoogle Scholar
  13. 13.
    de la Rochefordiere, A, Asselain, B, Campana, F,  et al. 1993Age as prognostic factor in premenopausal breast carcinomaLancet341103943PubMedGoogle Scholar
  14. 14.
    Allweis, TM, Boisvert, ME, Otero, SE, Perry, DJ, Dubin, NH, Priebat, DA 2002Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapyAm J Surg18321821PubMedGoogle Scholar
  15. 15.
    Newman, LA, Kuerer, HM, Hunt, KK,  et al. 1999Feasibility of immediate breast reconstruction for locally advanced breast cancerAnn Surg Oncol66715PubMedGoogle Scholar
  16. 16.
    Sultan, MR, Smith, ML, Estabrook, A, Schnabel, F, Singh, D 1997Immediate breast reconstruction in patients with locally advanced diseaseAnn Plast Surg383459discussion 350–1PubMedGoogle Scholar
  17. 17.
    Deutsch, MF, Smith, M, Wang, B, Ainsle, N, Schusterman, MA 1999Immediate breast reconstruction with the TRAM flap after neoadjuvant therapyAnn Plast Surg422404PubMedGoogle Scholar
  18. 18.
    Clough, KB, O’Donoghue, JM, Fitoussi, AD, Nos, C, Falcou, MC 2001Prospective evaluation of late cosmetic results following breast reconstruction. I. Implant reconstructionPlast Reconstr Surg10717029PubMedGoogle Scholar
  19. 19.
    Missana, MC, Levy, C, Barreau-Pouhaer, L, Janin, N 2000Radiotherapy and immediate breast reconstruction with myocutaneous flap in breast cancer of reserved prognosis (in French)Ann Chir Plast Esthet45839PubMedGoogle Scholar
  20. 20.
    Barreau-Pouhaer, L, Le, MG, Rietjens, M,  et al. 1992Risk factors for failure of immediate breast reconstruction with prosthesis after total mastectomy for breast cancerCancer70114551PubMedGoogle Scholar
  21. 21.
    Recht, A, Edge, SB, Solin, LJ,  et al. 2001Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical OncologyJ Clin Oncol19153969PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2005

Authors and Affiliations

  • Sebastien Gouy
    • 1
  • Roman Rouzier
    • 1
    • 2
  • Marie-Christine Missana
    • 1
  • David Atallah
    • 3
  • Omar Youssef
    • 4
  • Lise Barreau-Pouhaer
    • 1
  1. 1.Breast Surgery UnitInstitut Gustave-RoussyVillejuif CedexFrance
  2. 2.Department of Breast Medical OncologyUniversity of Texas M. D. Anderson Cancer CenterHouston
  3. 3.Department of Gynaecologic SurgeryHotel-DieuBeirut
  4. 4.Department of Surgical OncologyNational Cancer InstituteCairoEgypt

Personalised recommendations