Breast Cancer Recurrence Following Postmastectomy Reconstruction Compared to Mastectomy with no Reconstruction
Sashank Reddy, MD PhD, Salih Colakoglu, MD, Michael S. Curtis, MD, Janet H. Yueh, MD, Adeyemi Ogunleye, MD, Adam M. Tobias, MD, Bernard T. Lee, MD.
Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA, USA.
Continuing advances in breast reconstruction after mastectomy have provided surgeons with a multitude of reconstructive options. The development of autologous methods using local pedicled flaps or free tissue transfer has led to broader patient access and more natural results. Concerns remain, however, about the effects of the various reconstructive methods on ultimate oncologic outcome. While various studies have demonstrated the safety of individual methods, there is a paucity of data examining the full spectrum of reconstructive techniques. This study compares incidence, detection, and management of recurrent breast cancer in a large series of patients treated at a single center with mastectomy alone or with mastectomy and reconstruction.
A retrospective chart review was performed for all patients who underwent mastectomy and all patients who underwent reconstruction for breast cancer or DCIS at the Beth Israel Deaconess Medical Center between January 1999 and December 2006. The 1119 patients were divided into two groups: mastectomy and reconstruction (n = 676) and mastectomy alone (n = 443). Reconstructive options included tissue expander/ implants, latissimus, pedicled TRAM, free TRAM, DIEP, and SGAP. Patients were followed for a mean of 57.4 months. Data on patient demographics, reconstructive method, and presence of recurrence were obtained. Recurrent tumor size and location, time to recurrence, method of detection, and method of management were also analyzed.
The total incidence of recurrence - locoregional and/or distant - was 4.3% (29/676) in patients who had mastectomy with reconstruction and 11.1% (49/443) in patients who had mastectomy alone (p < 0.0001). The incidence of locoregional recurrence only was 1.6% (11/676) in patients who had mastectomy with reconstruction and 3.8% (17/443) in patients who had mastectomy alone (p = 0.0206). Of the 11 reconstructed patients with a locoregional recurrence, 72.7% (8/11) of the recurrences were detected by self or clinical examination. Mean time to detection was not significantly different between the two groups: 2.7 years in the reconstructed group and 2.2 years in the non-reconstructed group (p = 0.2614).
Reconstruction with a variety of methods does not adversely affect the incidence or time to detection of recurrent breast cancer. Therefore, surgeons can optimize reconstructive options for each clinical scenario without fear of compromising oncologic outcome. The best approach for tumor surveillance in patients with reconstruction remains unclear. Patients with locoregional recurrences after reconstruction were rare in our series and these lesions were often detected by self or clinical examination.
Table 1: Recurrence Rate
|Mastectomy and Reconstruction|
N = 676
N = 443
|All recurrence||29 (4.3%)||49 (11.1%)||0.0001|
|All locoregional||11 (1.6%)||17 (3.8%)||0.0206|
|Locoregional only||7 (1.0%)||9 (2.0%)||0.2010|
|Locoregional and distant||4 (0.6%)||8 (1.8%)||0.0734|
|Distant only||18 (2.7%)||32 (7.2%)||0.0003|
Back to Program