Concurrent adjuvant chemotherapy and immediate breast reconstruction with skin expanders after mastectomy for breast cancer

Background. Immediate breast reconstruction (IBR) by means of skin expander is currently one of the most widely used methods of breast reconstruction in mastectomized patients. However, given that many breast cancer patients usually receive adjuvant chemotherapy, the adoption of IBR raises new quest ions concerning possible cumulative toxicity. The present study reports our experience in the use of concurrent adjuvant chemotherapy and immediate br east reconstruction with skin expander after mastectomy for breast cancer a nd the acute cumulative toxicity of the treatments. Methods. We evaluated a consecutive series of 52 breast cancer patients who have received IBR by skin expander after radical mastectomy and adjuvant c hemotherapy concurrently during skin expansion between 1995 and 1998 (IBR/C T group). We identified two series of control patients treated during the s ame period: 51 consecutive patients undergoing radical mastectomy and IBR w ithout adjuvant chemotherapy (IBR group) and 63 consecutive patients underg oing radical mastectomy and adjuvant chemotherapy without IBR (CT group). F or each patient, we evaluated the incidence of surgical complications and c hemotherapy's side effects and dose intensity. Results. The interval between surgery and the start of expander inflation w as similar in IBR/CT (range 0-19, median 5 days) and IBR groups (range 0-40 , median 5 days) and the timing of inflation was not influenced by chemothe rapy. The overall incidence of surgical complications in patients undergoin g IBR was low: seroma in eight cases, infection in one, skin necrosis in on e, expander rupture in two and erythema in three. There were no statistical ly significant differences in the distribution of complications between the IBR/CT and IBR groups. The dose intensity of chemotherapy was similar betw een IBR/CT and CT groups, with a median dose intensity of 96% and 95% of th e projected dose, respectively. The only statistically significant differen ce in terms of chemotherapy side effects (p=0.03) was that stomatitis was m ore frequent and intense in the CT than in the IBR/CT group. Conclusions. Concurrent treatment with IBR and adjuvant chemotherapy appear s feasible and safe, it does not increase acute surgical complications or c hemotherapy side effects, and does not require any changes in dose intensit y or the timing of inflation.