Systemic Therapy for Early-Stage Breast Cancer

What the Plastic Surgeon Should Know

Chad M. Teven, MD; Daniel B. Schmid, MD; Mark Sisco, MD; James Ward, MD; Michael A. Howard, MD


ePlasty. 2017;17(e7) 

In This Article

Discussion and Recommendations

The treatment of breast cancer has evolved significantly over the past half century. In addition to primary surgical therapy and radiation therapy, systemic forms of therapy are frequently offered for early-stage disease. Therefore, an understanding of their effects on normal physiologic processes is crucial. In addition, abiding by data-driven recommendations regarding their use minimizes the potential complications associated with surgical procedures.

The following recommendations should be considered when offering reconstruction to patients who have or will receive chemotherapy, hormonal therapy, and/or targeted therapy as part of their care:

  1. The plastic surgeon should be present for discussions of the overall care plan with the patient and other members of the multidisciplinary treatment team.

  2. Ensure adequate time for the healing of surgical sites before the initiation of adjuvant chemotherapy.

  3. Ensure adequate time between the completion of neoadjuvant chemotherapy and surgery.

  4. Prior to any surgical procedure, ensure that required laboratory, radiologic, and clinical tests have been reviewed on the basis of the agents received by the patient.

  5. Determine whether the patient can safely undergo expander/implant-based and/or autologous-based reconstruction in light of the agents received and follow-up test results (eg, Do patients who have received cardiotoxic agents demonstrate the cardiac fitness to undergo a long, complex procedure?).

  6. Ensure discontinuation of tamoxifen 2 or more weeks to 4 weeks prior to surgery and resume only after the elevated thromboembolic risk has resolved.

  7. Remain educated on recent literature and the latest recommendations regarding the use of systemic agents in patients undergoing breast reconstruction