REVIEW The effects of neoadjuvant and adjuvant chemotherapy on the surgical outcomes of breast reconstruction Eugene Oh, Harvey Chim*, Hooman T. Soltanian Department of Plastic Surgery, Case School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA Received 9 November 2011; accepted 30 April 2012 KEYWORDS Breast reconstruction; Chemotherapy; Hormonal; Biologic; Breast cancer Summary Breast reconstruction following mastectomy has become, in many centers the standard of care. An increasingly encountered trend is the use of neoadjuvant chemotherapy to downstage high stage tumors and to decrease tumor burden prior to definitive oncologic surgery. These agents clearly provide a survival benefit, but also have the potential to adversely affect the surgical course of immediate and delayed breast reconstruction. The use of new biologic and hormonal agents may also have effects on surgery and reconstruction. Furthermore, chemotherapeutic agents as a whole may impair cellular functions necessary for normal recovery from surgery. In this paper we present a concise review for the reconstructive surgeon on adverse effects of chemotherapeutic, hormonal and biologic agents used for treat- ment of breast cancer, important perioperative issues, and also discuss their potential effect on breast reconstruction. ª 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Introduction Neoadjuvant and adjuvant therapies for breast cancer are increasingly being used and have become the standard of treatment for many breast cancers, particularly those deemed initially inoperable. This has resulted in reduction of recurrence and breast cancer related mortality by eliminating or delaying the development of occult micro- metastases. 1,2 Adjuvant chemotherapy refers to antitumor therapies following primary surgery and has been exten- sively used for breast cancer. Conversely, neoadjuvant therapy provides the clinical benefit of improved overall survival and long-term disease free survival in select women with early stage and locally advanced breast cancer by shrinking the tumor prior to definitive surgery. 2,3 * Corresponding author. Tel.: þ1 440 461 7999; fax: þ1 216 844 8667. E-mail address: harveychim@yahoo.com (H. Chim). 1748-6815/$ - see front matter ª 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2012.04.053 Journal of Plastic, Reconstructive & Aesthetic Surgery (2012) 65, e267ee280