Immediate autogenous breast reconstruction in clinically advanced disease

Breast reconstruction is pursued more aggressively today. We have offered primary autogenous reconstruction to patients with advanced disease and review herein our experience with these patients to define the benefits or problems of this practice. We carried out immediate autologous tissue breast reconstruction in 21 patients with disease in clinical stage IIb or higher, including 12 in stage III and 3 in stage IV. No patient experienced delay in the delivery of adjuvant chemotherapeutic or radiation treatment, and the reconstructed breasts tolerated these treatments well. Although 4 patients required biopsy of postoperative masses deep within the reconstructed breast, none proved to represent recurrence of disease. One patient developed cutaneous recurrence in a scar uniting mastectomy flap with reconstructive flap, and 2 had axillary recurrences. All were quickly detected and treated. Two patients with stage III disease and 2 with stage IV disease died from metastases, but with good local-regional control. Primary autogenous breast reconstruction may be offered to motivated patients regardless of disease stage.