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Immediate breast reconstruction following neoadjuvant chemotherapy raises concerns about increased perioperative complications and has the potential to delay planned adjuvant radiotherapy. This study examined the effect of neoadjuvant chemotherapy on reconstructive outcomes and the commencement of postoperative radiotherapy.A retrospective review of a single surgeon's immediate breast reconstructions performed from 2000 to 2007 was undertaken. The recipients of neoadjuvant chemotherapy were compared with nonrecipients (controls).One hundred seventy-one patients underwent 198 immediate breast reconstructions comprising 64 free tissue transfers, 74 pedicled flaps (latissimus dorsi and transverse rectus abdominis musculocutaneous), and 60 implant-only procedures. Fifty-three patients (31 percent), with a mean age of 47.8 years (range, 29 to 68 years), received neoadjuvant chemotherapy before mastectomy and reconstruction (58 reconstructions; 91 percent with flaps). The control group consisted of 118 patients (140 reconstructions; 61 percent with flaps) with a mean age of 50.4 years (range, 29 to 69 years), making them older (p = 0.08). The failed reconstruction rate was 2 percent (one of 58) for the neoadjuvant group and 2 percent (three of 140) for the control group, whereas the reoperation rates for major complications were 9 percent (five of 58) and 9 percent (13 of 140), respectively. Minor complications occurred in 10 percent (six of 58) of neoadjuvant reconstructions versus 6 percent (nine of 140) of controls (p = 0.380). Three-quarters of neoadjuvant patients received postoperative radiotherapy, compared with only a quarter of the controls. The commencement of radiotherapy was delayed in 10 percent (four of 39) of the chemotherapy recipients versus 11 percent (three of 28) of controls (p = 1.00).In this series, neoadjuvant chemotherapy did not appear to increase the risk of major surgical complications following mastectomy and immediate breast reconstruction or inordinately delay the institution of adjuvant radiotherapy.