Short- and long-term outcomes of chest wall resection and reconstruction for breast cancer

We sought to determine perioperative characteristics, rates of recurrence, and survival among patients who underwent chest wall resection for breast cancer.

We identified patients who underwent chest wall resection for breast cancer at our institution from 2000 to 2024. Progression-free survival and overall survival were estimated using the Kaplan-Meier approach. Cumulative incidence of local recurrence was calculated, and its association with disease-free interval was analyzed using Gray's test. Cox models quantified the association between patient characteristics and survival outcomes.

Sixty-three patients were included. Chest wall resection was performed for recurrent breast cancer in 81% of patients (51/63). Most patients underwent rib resection (55/63; 87%) and partial or complete sternal resection (37/63; 59%). Fifty-five patients (87%) had a prosthesis placed for reconstruction; 55 patients (87%) received myocutaneous flaps. R0 resection was performed in 52 patients (83%). Eight patients (13%) had grade 3 or greater complications, nearly all of which (n = 7) were flap infection or necrosis. No patients died within 30 days; 3 patients (5%) died within 90 days. Median follow-up was 10 years (interquartile range, 5-17 years). At 5 years, cumulative incidence of local recurrence was 32%, progression-free survival was 13%, and overall survival was 31%.

Among patients with locally advanced or recurrent breast cancer, chest wall resection can provide local control and has acceptable morbidity and mortality. Given the known effect of chest wall disease on quality of life, chest wall resection should be considered in the multimodal management of patients with locally aggressive breast cancer.