Oncological safety of immediate rectus abdominis myocutaneous breast reconstruction in patients with locally advanced disease (stage IIb and III)

Abstract

Background: The management of locally advanced (Stage IIb and III) breast cancer is challenging. It often includes multimodal treatment with systemic therapy and/or radiation therapy and surgery. Immediate breast reconstruction has not traditionally been performed in these patients. We review the results of immediate rectus abdominis musculo-cutaneous (TRAM/VRAM) flap in 60 patients treated for Stage IIb and III breast cancer. Materials and Methods: Data were collected prospectively on 60 patients diagnosed with Stage IIb (32 patients) and Stage III (28 patients) breast cancer between May 2008 and May 2012. All patients had mastectomy and immediate rectus abdominis myocutaneous reconstruction (TRAM in 40 patients and VRAM in 20 patients). All patients received primary systemic therapy, and all patients received postoperative radiotherapy to the operative site. Results: Mean age was 40.13 (range 28-53) years, mean hospital stay was 8.86 days and mean follow-up for the group was 28 months. Neither of them developed local disease recurrence in the operative site till the last follow-up. Eight (13.3%) patients had some delay in chemo-radiation therapy due to flap-related complications. Flap-related complications were present in eight patients (partial flap failure in four and superficial skin necrosis in four). There was no adverse effect of chemo-radiation therapy on reconstructed breast. Conclusion: Immediate TRAM/VRAM breast reconstruction for locally advanced breast cancer is not associated with a significant delay in adjuvant therapy or an increased risk of local relapse. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of locally advanced breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.

Key words

Immediate breast reconstruction - rectus abdominis myocutaneous reconstruction; mastectomy

Publikationsverlauf

Artikel online veröffentlicht:
31. Dezember 2020

• References

• 1 Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106-30.
• 2 Burjet WC, editor. Surgical Papers by William Stewart Halsted. Baltimore: Johns Hopkins Press; 1924.
• 3 Goldwyn R. Vincenz Czerny and the beginnings of breast reconstruction. Plast Reconstr Surg 1978;61:673-81.
• 4 Bostwick J 3^rd , Schelfan M. The Latissmus dorsi musculocutaneous flap: A one stage breast reconstruction. Clin Plast Surg 1980;7:71-8.
• 5 Mendelson BC. The evolution of breast reconstruction. Med J Aust 1982;1:7-8.
• 6 Manchot C. Die Hautarterien des menschilchen Korpers. Leipzig: Vogel; 1989.
• 7 Veronesi U, Banfi A, Salvadori B. Breast conservation is the treatment of choice in Small breast cancer: Long term results of a randomized trial. Eur J Cancer 1990;26:668-70.
• 8 Schain WS, Wellisch DK, Pasnau RO, Landsverk J. The sooner the better: A study ofpsychological factors in women undergoing immediate versus delayed breast reconstruction. Am J Psychiatry 1985;142:40-6.
• 9 Noone RB, Frazier TG, Hayward CZ, Skiles MS. Patient′s acceptance of immediate reconstruction following mastectomy. Plast Reconstr Surg 1982;69:632-40.
• 10 Laurie A. Stevens, MH Mc Grath, RG Druss. The psychological impact of the immediate breast reconstruction for women with early breast cancer. Plast Reconstr Surg .73, 1984, 619-26.
• 11 Elliott LF, Eskenazi L, Beegle PH Jr, Podres PE, Drazan L. Immediate TRAM Flap BreastReconstruction: 128 Consecutive Cases. Plast Reconstr Surg 1993;92:217-27.
• 12 Eifel P, Axelson JA, Costa J, Crowley J, Curran WJ Jr, Deshler A, et al. National Institutes of Health Consensus Development Conference Statement: Adjuvant therapy for breast cancer, November 1-3, 2000. J Natl Cancer Inst 2001;93:979-89.
• 13 Styblo TM, Lewis MM, Carlson GW, Murray DR, Wood WC, Lawson D, et al. Immediate breast reconstruction for stage III breast cancer using transverse rectus abdominis musculocutaneous (TRAM) flap, Ann Surg Oncol 1996;3:375-80.
• 14 Foster RD, Hansen SL, Esserman LJ, Hwang ES, Ewing C, Lane K, et al. Safety of immediate transverse rectus abdominis myocutaneous Breast reconstruction for patients with locally advanced disease. Arch Surg 2005;140:196-200.
• 15 Mehta VK, Goffinet D. Postmastectomy radiation therapy after TRAM flap breast reconstruction. Breast J 2004;10:118-22.
• 16 Carlson GW, Styblo TM, Lyles RH, Bostwick J, Murray DR, Staley CA, et al. Local recurrence after skin-sparing Mastectomy: Tumor biology or surgical conservatism? Ann surgoncol 2003;10:108-12.
• 17 Medina-Franco H, Vasconez LO, Fix RJ, Heslin MJ, Beenken SW, Bland KI, et al. Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Ann surg 2002;235:814-9.
• 18 Foster RD, Esserman LJ, Anthony JP, Hwang ES, Do H. Skin-sparing mastectomy andImmediate Breast Reconstruction: A Prospective Cohort Study for the Treatment ofAdvanced Stages of Breast Carcinoma.Anns Surg Oncol 2002;9:462-6.
• 19 Newman LA, Kuerer HM, Hunt KK, Ames FC, Ross MI, Theriault R, et al. Feasibility of immediate breast reconstruction for locally advanced breast cancer. Ann Surgoncol 1999;6:671-5.
• 20 Downes KJ, Glatt BS, Kanchwala SK, Mick R, Fraker DL, Fox KR, et al. Skin-sparing mastectomy and immediate breast reconstruction is an acceptable treatment option for patients with high risk breast carcinoma. Cancer 2005;103:906-13.