Breast Reconstruction for Inflammatory Breast Cancer: Improving Patient-Reported Outcomes in a High-Risk Population

Inflammatory breast cancer (IBC) is an aggressive form of breast cancer that requires extensive multimodal treatment, which poses unique reconstructive challenges. Despite advances in trimodal therapy, optimal timing and outcomes of breast reconstruction in IBC remain poorly characterized. This study aims to evaluate clinical outcomes, complications, and patient-reported outcomes associated with delayed breast reconstruction in patients with IBC.

We conducted a retrospective analysis of patients with stage III IBC who completed trimodal therapy between 1997 and 2023 using an institutional IBC database. Clinical and oncologic outcomes were analyzed. Reconstruction-specific outcomes were assessed through chart review of patients undergoing delayed autologous reconstruction (predominantly DIEP and latissimus dorsi flaps). Patient-reported outcomes were evaluated by using BREAST-Q scales pre- and post-reconstruction, with comparisons to non-IBC comparison groups.

Of 248 eligible patients with stage III IBC, 49 (19.8%) underwent delayed breast reconstruction, predominantly autologous (87.8%). Reconstruction was associated with younger age (45.4 vs. 51.3 years, odds ratio [OR] = 0.95, p < 0.01), lower BMI (28.3 vs. 30.7, OR = 0.93, p = 0.04), and fewer comorbidities (0.7 vs. 1.1, OR = 0.61, p < 0.01). No reconstructed patients experienced recurrence within 1 year post-mastectomy, aligning with guidelines recommending delayed reconstruction. Reconstruction-specific complication rates were comparable to existing literature. BREAST-Q scores significantly improved post-reconstruction, with IBC cohort achieving satisfaction and quality-of-life outcomes comparable to non-IBC controls.

Delayed breast reconstruction is safe and effective in carefully selected patients with stage III IBC. Reconstruction offers significant psychosocial benefits without compromising oncologic outcomes. These findings corroborate current guidelines and provide valuable evidence for patient counseling and surgical decision-making.