Immediate breast reconstruction with the TRAM flap after neoadjuvant therapy

Neoadjuvant therapy is a relatively new weapon in the chemotherapeutic arse nal against breast carcinoma. However, there has been concern that preopera tive chemotherapy might lead to an increased incidence of complications and delays in postoperative treatment. A retrospective study was performed at M.D. Anderson Cancer Center of all patients with locally advanced breast ca ncer who had undergone neoadjuvant therapy followed by mastectomy and immed iate reconstruction with the transverse rectus abdominis musculocutaneous ( TRAM) flap. Patients were evaluated for the incidence of complications and any delays in resumption of postoperative chemotherapy. Thirty-one patients underwent immediate reconstruction with the TRAM flap. Twenty-two patients were reconstructed with free TRAM flaps whereas 9 patients were reconstruc ted with pedicled TRAM flaps. Seventeen patients (55%) had complications po stoperatively, but only 2 patients (6%) had a delay in the resumption of ch emotherapy. Seven patients were smokers, five (71%) of whom had complicatio ns, which was nota significant difference from the rate in nonsmokers (50%) . Although delays in postoperative chemotherapy occurred in smokers (29%, v s. 0% in nonsmokers), the number of patients was too small to attain statis tical significance. Based on this study it is felt that immediate reconstru ction with the TRAM flap can be performed safely in patients on a neoadjuva nt protocol. Although not contraindicated, immediate reconstruction with th e TRAM flap in smokers in this setting may be associated with higher morbid ity.