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Locoregional Cancer Recurrence after Breast Reconstruction: Detection, Management, and Secondary Reconstructive
Michael N Mirzabeigi1, Irfan A Rhemtulla1, Elizabeth S Mcdonald1
1From the Division of Plastic Surgery, Department of Surgery, and the Departments of Radiology and Surgery, University of Pennsylvania Health System.
Plastic and Reconstructive Surgery
|February 22, 2019
Summary
Locoregional recurrence after breast reconstruction presents challenges. Patient concern is the most common detection method, and factors like age and recurrence plane influence salvage flap needs and reconstruction success.
Area of Science:
- Oncology
- Plastic Surgery
- Breast Reconstruction
Background:
- Locoregional recurrence after postmastectomy breast reconstruction presents significant diagnostic and operative challenges.
- This study focuses on the detection, management, and reconstructive strategies for these recurrences.
Purpose of the Study:
- To examine the detection, management, and reconstructive strategies for locoregional recurrence following postmastectomy breast reconstruction.
- To identify factors influencing the need for secondary salvage flaps and the success of initial reconstructions.
Main Methods:
- Retrospective review of breast cancer patients treated between January 2000 and July 2014.
- Collection of descriptive factors and operative details for patients with locoregional recurrence, including subsequent reconstructive operations.
- Development of a surveillance/management algorithm by a multidisciplinary team.
Main Results:
- 41 patients with locoregional recurrence were identified, with a mean time to recurrence of 4.6 years.
- Two- and 5-year survival rates post-recurrence were 88% and 39%, respectively.
- Recurrence occurred in subcutaneous (27%), subcutaneous/pectoralis (24%), chest wall (37%), and axillary (12%) planes. Patient concern was the most frequent detection method. Older age, longer time to recurrence, and prior chemotherapy were associated with needing a secondary salvage flap. Subcutaneous recurrence was less likely to require a secondary flap. Factors associated with loss of initial reconstruction included lower BMI, pectoralis invasion, and implant reconstruction.
Conclusions:
- Effective detection and management of locoregional recurrence necessitate thorough physical examination and appropriate imaging.
- Key factors influencing the success of salvaging the initial breast reconstruction include patient's body mass index, the recurrence plane, and the type of initial reconstruction.
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