Immunotherapy and Breast Reconstruction: Opportunities, Challenges, and Future Directions.

Immunotherapy is transforming breast cancer management, but it also presents new challenges for surgical and reconstructive practice. This review summarizes current evidence on immune checkpoint inhibitors, perioperative safety, and immune-related adverse events, highlighting their impact on surgical timing, postoperative recovery, and reconstructive outcomes. We also discuss interactions between implants and the tumor immune microenvironment and emphasize the need for individualized perioperative management. Finally, we identify key research gaps, including long-term toxicity, real-world surgical outcomes, and predictive biomarkers to guide reconstructive surgeons in integrating immunotherapy into multidisciplinary care.