Reconstructive outcomes in patients with sarcoma of the breast

Primary soft-tissue sarcomas account for less than 1 percent of all breast malignancies. Many of these are associated with prior radiation therapy. Few studies have evaluated this patient population. The purpose of this study was to examine reconstruction techniques and outcomes in a cohort of patients with breast sarcoma to elucidate the optimal type and timing of reconstruction.

The authors conducted a retrospective review of all patients diagnosed and treated for soft-tissue breast sarcomas between July 1, 1988, and December 9, 2009, at a tertiary cancer center. Data collected included demographics, histology, oncologic and reconstructive treatment, and clinical outcomes.

Twenty-three breast sarcoma patients underwent 24 reconstructions. The mean age at diagnosis was 42 years (range, 17 to 78 years). The most common histologic finding was angiosarcoma; six of the 11 angiosarcomas developed following irradiation for either breast carcinoma or lymphoma. The median follow-up was 44 months. Twenty patients were alive through the follow-up period. Reconstruction was immediate in 20 cases and delayed in four. The reconstruction used autologous tissue in 16 cases, implants in five, and both in three. All patients who underwent irradiation during treatment underwent autologous tissue reconstruction. Surgical complications included implant displacement, tissue expander displacement, total flap loss, seroma, implant exposure, and partial skin graft loss.

Soft-tissue breast sarcomas are uncommon and demand aggressive, multimodal treatment and well-planned reconstruction. Most sarcoma patients receive radiotherapy; to minimize complications, we recommend delayed autologous reconstruction after completion of radiotherapy.