Chest wall resections for advanced breast cancer: a narrative review

Advanced breast cancer (BC) can involve the chest wall through local invasion by the primary tumor, locoregional recurrence, hematogenous metastasis, or sternum infiltration of the internal mammary chain lymph nodes. The purpose of this article is to review indications and the methods of chest wall resection and reconstruction in patients with advanced BC.

An online literature search was conducted on PubMed database using the following keywords: "chest wall reconstruction" or "chest wall resection" and "breast cancer". Articles in languages other than English were excluded.

The treatment options should be discussed by a multidisciplinary team. The surgical principles include complete en bloc resection of the tumor including all involved or damaged skin, muscle and part of chest wall including ribs, complete or partial sternum and clavicles, as required, to achieve wide clear margins. The chest wall defect should be reconstructed with a good functional result. The optimal strategy for chest wall reconstruction depends on factors such as the defect`s size, location, and previous radiation or surgical intervention. A part of the reconstruction involves stabilizing the chest wall. Additionally, the defect should be covered with well-vascularized tissue, often necessitating reconstruction with muscle flaps or myocutaneous flaps.

A resection and reconstruction of the chest wall may be the best treatment option to achieve a high quality of life and favorable long-term outcomes, mostly as part of multimodality treatment for highly selected patients.