• Anne Warren Peled, Kaoru Itakura, Robert D Foster, Debby Hamolsky, Janet Tanaka, Cheryl Ewing, Michael Alvarado, Laura J Esserman, and E Shelley Hwang.
• Division of Breast Surgery, Department of Surgery, University of California-San Francisco, 1600 Divisadero Street, San Francisco, CA 94115, USA.
• Arch Surg. 2010 Sep 1;145(9):880-5.

ObjectivesTo determine the impact of chemotherapy and the timing of chemotherapy on postoperative outcomes after mastectomy and immediate breast reconstruction.DesignRetrospective review.SettingUniversity tertiary care institution.PatientsOne hundred sixty-three consecutive patients undergoing mastectomy and immediate breast reconstruction.InterventionSystemic chemotherapy for breast cancer.Main Outcome MeasuresPostoperative complications following mastectomy and immediate breast reconstruction.ResultsOne hundred sixty-three patients underwent mastectomy and immediate breast reconstruction during the study period, with a mean postoperative follow-up of 19.2 months. Sixty-six percent of the patients had expander/implant reconstruction, while 33% underwent autologous reconstruction. Fifty-seven patients received neoadjuvant chemotherapy and 41 received postoperative chemotherapy. Eighteen patients (44%) in the adjuvant chemotherapy cohort developed postoperative infections, compared with 13 patients (23%) in the neoadjuvant chemotherapy group and 16 patients (25%) who did not receive any chemotherapy (P = .05). Overall, 31% of patients had a complication requiring an unplanned return to the operating room; this rate did not differ between groups (P = .79). Of patients who underwent expander/implant reconstruction, 8 women (26%) in the neoadjuvant chemotherapy cohort, 7 women (22%) in the adjuvant chemotherapy cohort, and 8 women (18%) without chemotherapy required expander or implant removal (P = .70).ConclusionsAlthough the highest rate of surgical site infections was in the adjuvant chemotherapy group, there were no differences between groups with respect to unplanned return to the operating room, expander loss, and donor-site complications. Neither the inclusion of chemotherapy nor the timing of its administration significantly affected the complication rates after mastectomy and immediate breast reconstruction in this population.

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