How should we manage abemaciclib in the peri-operative period during secondary breast reconstruction: balancing oncologic benefit and surgical safety.

Abemaciclib, a CDK4/6 inhibitor, has emerged as a pivotal therapy in hormone receptor-positive, HER2-negative breast cancer, including in the adjuvant setting for high-risk early disease. Its integration into long-term oncologic strategies poses new challenges for peri-operative management, particularly in the context of secondary breast reconstruction. Preclinical studies suggest impaired wound healing potential, while clinical data highlight an increased risk of venous thromboembolism. No study to date has specifically addressed surgical outcomes under abemaciclib therapy. We call for the need of a clinical trial in abemaciclib perioperative management and propose pragmatic peri-operative strategies to optimize patient safety without compromising oncologic benefit.