[What surgical procedure for immediate breast reconstruction after preoperative radiotherapy and chemotherapy?]. / Quel type de reconstruction mammaire immédiate après radiothérapie externe et chimiothérapie pré-opératoire?

OBJECTIVE: To evaluate retrospectively the morbidity of four different surgical procedures for immediate breast reconstruction (IBR) in the setting of neoadjuvant chemotherapy and radiotherapy, and to determine which procedure is best adapted to these circumstances. PATIENTS AND METHODS: Immediate breast reconstruction was undertaken in 101 patients who had undergone neoadjuvant chemotherapy and radiotherapy for invasive breast carcinoma. IBR was accomplished by transverse rectus abdominis musculocutaneous flap (TRAM) in 38 patients, by latissimus dorsi musculocutaneous flap with prosthesis (LDMP) in 32, by autologous latissimus dorsi musculocutaneous flap (ALDM) in 15, and by simple prosthetic implant in 26. RESULTS: The complication rates for TRAM. LDMP, ALDM and prosthesis were respectively 50%, 37.5%, 85%, and 62%. The need for additional surgical procedure(s) was respectively 29%, 15%, 6%, and 56%. The complication rate was significantly worse (p=0.013) for ALDM (RR=1.73, IC95%=1.12-2.69), and the need for surgical revision was worst (p=0.00087).for simple prosthetic implant (RR=1.99, IC95%=1.11-3.59). CONCLUSION: IBR using musculocutaneous flap is superior to the use of prosthetic implant in patients having undergone neoadjuvant chemotherapy and radiotherapy.