How long should a patient stop systemic therapy before breast reconstruction, and is stopping appropriate at all? For several current breast cancer drugs, the evidence does not yet give a clear answer.
Dr. Azadeh Nasrazadani, assistant professor of breast medical oncology at The University of Texas MD Anderson Cancer Center, addressed this gap in the session Understanding the Effects of Breast Cancer Medications and Reconstruction at Plastic Surgery The Meeting 2026, organized and hosted by the American Society of Plastic Surgeons (ASPS), in Houston, Texas. She reviewed how systemic therapies affect surgical safety and when interruption is worth the added recurrence risk.
Surgical Risk by Drug Class
She first graded the main drug classes by perioperative safety. Chemotherapy and antibody-drug conjugates may carry overlapping risks for wound healing and surgical complications. Tamoxifen raises concern for venous thromboembolism. Aromatase inhibitors and several antibody therapies were described as generally safe, with clinical caveats. Immunotherapy calls for added caution when a patient has an active treatment-related adverse event or needs steroids.
Then she reversed the question. "How essential are they? ... Is it appropriate to interrupt therapy if you need to? Really, should you?" she asked.
When to Hold, and for How Long
For traditional chemotherapy, she described waiting 3 to 8 weeks between the last dose and surgery as the usual window, a timing she did not extend to other systemic therapies. Endocrine therapy timing depends on the treatment and the patient. Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors were particularly complex. Current evidence does not establish an ideal hold duration, and the decision carries the most weight for patients at high recurrence risk. She advised deciding endocrine therapy and CDK4/6 inhibitor holds case by case with the oncology team.
Newer survival data add to the difficulty. "When is the appropriate time to hold off drugs and to interrupt that? And especially now with evolving data suggesting that there actually is survival benefit with these medications, it is very hard to justify what the right number will look like," she said.
Medical oncology relies on national and international guidelines built on large bodies of research, she explained. "We would like the same kind of guidance for surgery, but treatments and situations are changing quickly," she said.
Dr. Nasrazadani stressed individualized discussion and cautioned against holds that could pose too much recurrence risk, particularly when adjuvant therapies offer recurrence or survival benefit. In her view, reconstruction timing is a decision shared with the oncology team.
Key takeaway: Dr. Nasrazadani recommends individualized decisions, made with the oncology team, on pausing systemic therapy around breast reconstruction, with particular care for patients on CDK4/6 inhibitors at high recurrence risk, since current evidence does not establish an ideal hold duration.