Reconstruction at The Edge of Oncologic Safety: Immediate Latissimus Dorsi Flap After Neoadjuvant Chemotherapy in Locally Advanced Triple Negative Breast Cancer
Abstract
Triple negative breast cancer (TNBC) is an aggressive subtype characterized by rapid progression, early recurrence, and limited targeted therapies. Neoadjuvant chemotherapy (NACT) is standard in locally advanced TNBC to improve resectability and assess tumor response. Immediate breast reconstruction (IBR) after NACT was historically approached with caution because of concerns regarding wound complications, treatment delay, and oncologic safety; growing evidence, however, now supports its oncologic safety when patients are carefully selected, so that the clinically relevant question has shifted from whether IBR should be offered to how candidates should be chosen. A 49 years old woman presented with a 6 × 8 cm ulcerated right breast mass and ipsilateral axillary lymphadenopathy. Biopsy confirmed grade II invasive carcinoma of no special type (NST), ER/PR/HER2 negative. After three cycles of cyclophosphamide, doxorubicin, and paclitaxel, a partial clinical response was achieved. She underwent modified radical mastectomy with axillary dissection and immediate pedicled latissimus dorsi (LD) flap reconstruction for an 8 × 18 cm defect. Final pathology showed residual disease with Miller–Payne grade 3 response and negative lymph nodes. Recovery was uneventful, and adjuvant therapy commenced without delay. With appropriate patient selection, negative margins, and multidisciplinary planning, immediate LD flap reconstruction can provide reliable coverage in high risk fields without compromising oncologic outcomes. This case supports the feasibility and oncologic prudence of immediate LD flap reconstruction after NACT in selected patients with locally advanced TNBC, while underscoring that broader conclusions require validation beyond a single case.
Keywords: Breast reconstruction, latissimus dorsi flap, neoadjuvant chemotherapy, triple negative breast cancer
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Andreev DA, Zavyalov AA. Triple-negative breast cancer: new options for systemic targeted therapy. A review. J Modern Oncol. 2022;24(3):368-72.
Hao X, Jiang Z. Hot issues in triple-negative breast cancer. Cancer Biol Med. 2024;20(12):981-4.
Konstantinova VV, Dashyan GA, Ahmedov RM, Belousav AM. Pathological complete response of locally advanced triple-negative breast cancer: case report. Siberian J Oncol. 2024;23(4):186-93.s
Mason SRE, Willson ML, Egger SJ, Beith J, Dear RF, Goodwin A. Platinum-based chemotherapy for early triple-negative breast cancer. Cochrane Database Syst Rev. 2023;9(9):CD014805.
Raxith Sringeri R. Neoadjuvant chemotherapy in triple-negative breast cancer: impact on early stage and outcomes-comprehensive review. Indian J Surg Oncol. 2024;15(Suppl 3):501–8.
Sin TH, Huang J, Nie L, Mao F, Shen S, Li Y, et al. Successful treatment of enormous locally advanced breast cancer through neoadjuvant chemotherapy and surgical intervention: a case report. Gland Surg. 2024;13(6):1126-36.
Hari MD, Wiramur A, Pradana HY. Revitalizing femininity: successful latissimus dorsi flap reconstruction following breast cancer mastectomy - a case report. J Ilm Kedokt Kesehat. 2025;12(7):1481-88.
Banys-Paluchowski M, Brus L, Krawczyk N, Kopperschmidt SV, Gasparri ML, Bündgen N, et al. Latissimus dorsi flap for breast reconstruction: a large single-institution evaluation of surgical outcome and complications. Arch Gynecol Obstet. 2023;309(1):269-80.
Clement Z, Egbeare D, Kollias J, Gill G, Whitfield R, Bingham J, et al. Safety and efficacy of immediate autologous breast reconstruction after mastectomy in patients undergoing neoadjuvant chemoradiotherapy for locally advanced breast cancer. Breast Dis. 2022;41(1):267-72.
Sabitovic A, Trøstrup H, Damsgaard TE. The impact of neoadjuvant chemotherapy on surgical outcomes following autologous and implant-based immediate breast reconstruction: A systematic review and meta-analysis. J Plast Reconstruct Aesth Surg. 2023;87:17-23.
Syed A, Thomas H, Smith S, Ramakrishnan V. Do modern methods of post-mastectomy immediate breast reconstruction for breast cancer delay adjuvant therapy? Glob Surg. 2018; 4(3):1-6.
D'Alessandro GS, Munhoz AM, Takeuchi FM, Povedano A, Góes JCS. Neoadjuvant chemotherapy impact on outcomes in immediate breast reconstruction with latissimus dorsi flap and silicone implant. J Surg Oncol. 2024;129(2):208-18.
D'Alessandro GS, Munhoz AM, Takeuchi FM, Povedano A, Goes JCS. Is immediate breast reconstruction with a latissimus dorsi myocutaneous flap safe for starting adjuvant chemotherapy in patients with breast cancer? Clin Breast Cancer. 2024;24(5):e408-16.
Hernandez DFN, Santiago AA, Tijerina SFE, Hernández AC, Solís LFP, Ferrel EAP, et al. Breast reconstruction with latissimus dorsi flap. Int J Med Med Sci Clin Res Stud. 2024;4(8):1447-51.
Zhan QH, Fu JQ, Fu FM, Zhang J, Wang C. Survival and time to initiation of adjuvant chemotherapy among breast cancer patients: a systematic review and meta-analysis. Oncotarget. 2017;9(2):2739-51.
Denkert C, von Minckwitz G, Darb-Esfahani S, Lederer B, Heppner BI, Weber KE, et al. Tumour-infiltrating lymphocytes and prognosis in different subtypes of breast cancer: a pooled analysis of 3771 patients treated with neoadjuvant therapy. Lancet Oncol. 2018;19(1):40-50.
Nogi H, Ogiya A, Ishitobi M, Mori H, Shimo A, Narui K, et al. Impact of neoadjuvant chemotherapy on the safety and long-term outcomes of patients undergoing immediate breast reconstruction after mastectomy. Breast Cancer. 2024;31(3):507-18.
DOI: https://doi.org/10.37905/jmhsj.v5i2.37414
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