Is Immediate Breast Reconstruction With a Latissimus Dorsi Myocutaneous Flap Safe for Starting Adjuvant Chemotherapy in Patients With Breast Cancer?

• Published in: Clinical breast cancer 2024-07, Vol.24 (5), p.e408-e416
• Main Authors: D'Alessandro, Gabriel Salum, Munhoz, Alexandre Mendonça, Takeuchi, Fabiana Midori, Povedano, Alejandro, Goes, João Carlos Sampaio
• Format: Article
• Language: English
• Subjects: Adjuvant Chemotherapy; Adult; Aged; Breast Cancer; Breast Implants - adverse effects; Breast Neoplasms - drug therapy; Breast Neoplasms - surgery; Chemotherapy, Adjuvant - adverse effects; Chemotherapy, Adjuvant - methods; Female; Humans; Mammaplasty; Mammaplasty - adverse effects; Mammaplasty - methods; Mastectomy; Mastectomy - adverse effects; Middle Aged; Myocutaneous flap; Myocutaneous Flap - transplantation; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Superficial Back Muscles - transplantation; Time-to-Treatment - statistics & numerical data
• ISSN: 1526-8209; 1938-0666; 1938-0666
• DOI: 10.1016/j.clbc.2024.03.003

•Prolonged operating time and surgical morbidity may compromise oncological outcomes.•Patients with ≥ 2 comorbidities were 3.35 times more likely to have major complications.•Major complications were associated with delayed initiation of adjuvant chemotherapy.•Crucial risk factors should be considered when indicating patients for IBR with LDM flap. Immediate breast reconstruction following mastectomy reduces perceptions of mutilation and femininity issues in oncological patients, but surgical complications should not delay chemotherapy. This study evaluated postsurgical complications in patients who underwent radical breast surgery followed by immediate reconstruction with latissimus dorsi myocutaneous flaps and silicone implants, along with resulting impacts in delaying chemotherapy. This retrospective study utilized a prospectively maintained database. Clinical, surgical, and oncological data from 196 women were collected according to the operated side. Patients were grouped according to the time elapsed between surgery and the first cycle of adjuvant chemotherapy: ≤ 60 days (group 1), 61 to 90 days (group 2), or > 90 days (group 3). A total of 198 immediate reconstructions were performed on 196 patients between August 1, 2010 and March 31, 2020; after surgery, 47.4% had minor complications and 7.1% had major complications. Ninety-six patients (48.5%) received adjuvant chemotherapy. The mean time elapsed between surgery and the first chemotherapy cycle was 65.4 days (median: 59), with 52.7% of the patients assigned to group 1, 37.4% to group 2, and 9.9% to group 3. The occurrence of major postoperative complications significantly affected the start of chemotherapy (64.0 vs. 94.5 days; P = .044). Additionally, patients with 2 or more comorbidities were more likely to experience major complications (OR: 3.35; 95% CI: 1.03-10.95; P = .045) than those with 1 or 0. Major postoperative complications significantly delayed initiation of adjuvant chemotherapy in oncological patients who underwent radical breast surgery followed by immediate reconstruction with a latissimus dorsi myocutaneous flap and silicone implants. This study assessed the impact of immediate breast reconstruction on the timing of adjuvant chemotherapy. The mean time elapsed between surgery and the first chemotherapy cycle was 65.4 days, with 52.7% of patients receiving chemotherapy within 60 days. Major postoperative complications significantly delayed the start of chemotherapy (64.0 vs. 94.5