Objective To explore the clinical feasibility and safety of immediate free autologous flap breast reconstruction

and chest wall repair after neoadjuvant chemotherapy in patients with breast cancer. Methods Clinical data of 42 patients who underwent immediate autologous flap breast reconstruction or chest wall repair from June 2023 to December 2025 were retrospectively collected. All patients were divided into two groups according to treatment regimens： the neoadjuvant chemotherapy group （26 cases， including 1 male breast cancer patient and 1 patient with bilateral breast cancer） and the control group （16 cases， including 5 patients with carcinoma in situ）. The clinicopathological characteristics， perioperative indicators， and incidence of complications such as flap necrosis were compared between the two groups. The BREAST-Q scale was adopted to evaluate patients’ satisfaction with postoperative breast appearance and function. Results There were no statistically significant intergroup differences in age， body mass index （BMI）， smoking history， underlying diseases （diabetes， hypertension）， tumor molecular subtypes and distribution of flap types （P>0.05）. No significant differences were  found in perioperative indicators including intraoperative blood loss， operative duration， postoperative drainage duration，total drainage volume and length of hospital stay between the two groups （P>0.05）. The overall postoperative complication rates were comparable between groups. Complications occurred in 3 patients （11.5%） in the neoadjuvant chemotherapy group and 1 patient （6.3%） in the control group； All complications presented as partial marginal flap necrosis and healed after  secondary surgical intervention. All patients were followed up for at least 6 months after surgery， and both groups reported high postoperative satisfaction without significant intergroup difference （P>0.05）. Conclusion Immediate free autologous flap breast reconstruction or chest wall repair performed after neoadjuvant chemotherapy for breast cancer is as safe and feasible as primary immediate reconstruction without prior chemotherapy. This approach yields high flap survival rate， low complication rates and satisfactory patient outcomes， without increasing perioperative risks or hospital stay. It is a safe and effective reconstructive strategy worthy of wide clinical promotion and application.

Breast cancer, Neoadjuvant chemotherapy, Free autologous flap, Breast reconstruction, Chest wall repair,