Is mammography useful in screening for local recurrences in patients with TRAM flap breast reconstruction after mastectomy for multifocal DCIS?
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Background: Skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction is being used more often for the treatment of breast cancer. Mammography is not used routinely to evaluate TRAM flaps in women who have undergone mastectomy. We have identified the potential value of its use in selected patients.
Methods and Results: We report on four women who manifested local recurrences in TRAM flaps after initial treatment for ductal carcinoma in situ (DCIS) or DCIS with microinvasion undergoing skin-sparing mastectomy and immediate reconstruction. All four patients presented with extensive, high-grade, multifocal DCIS that precluded breast conservation. Three of four mastectomy specimens demonstrated tumor close to the surgical margin. Three of the four recurrences were detected by physical examination; the remaining local recurrence was documented by screening mammography. The recurrences had features suggestive of malignancy on mammography.
Conclusion: We conclude that all patients undergoing mastectomy and TRAM reconstruction for extensive, multifocal DCIS should undergo regular routine mammography of the reconstructed breast. Our experience with this subgroup of patients raises concern about the value of skin-sparing mastectomy with immediate reconstruction for therapy. Adjuvant radiation therapy should be recommended for those patients with negative but close surgical margins.
- Johnson CH, van Heerden JA, Donohue JH, Martin JK Jr, Jackson IT, Ilstrup DM. Oncological aspects of immediate breast reconstruction following mastectomy for malignancy.Arch Surg 1989;124:819–24.
- Kroll SS, Ames F, Singletary SE, Schusterman MA. The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast.Surg Gynecol Obstet 1991;172:17–20.
- Noguchi M, Fukushima W, Ohta N, et al. Oncological aspect of immediate breast reconstruction in mastectomy patients.J Surg Oncol 1992;50:241–6.
- Patel RT, Webster DJ, Mansel RE, Hughes LE. Is immediate post-mastectomy reconstruction safe in the long-term.Eur J Surg Oncol 1993;19:372–5.
- Schain WS. Breast reconstruction. Update of psychosocial and pragmatic concerns.Cancer 1991;68:1170–5.
- Schain WS, Wellisch DK, Pasnau RO, Landsverk J. The sooner the better: a study of psychological factors in women undergoing immediate versus delayed breast reconstruction.Am J Psychiatry 1985;142:40–6.
- Eberlein TJ, Crespo LD, Smith BL, Hergrueter CA, Douville L, Eriksson E. Prospective evaluation of immediate reconstruction after mastectomy.Ann Surg 1993;218:29–36.
- Noone RB, Murphy JB, Spear SL, Little JW 3d. A 6-year experience with immediate reconstruction after mastectomy for cancer.Plast Reconstr Surg 1985;76:258–69.
- Schusterman MA, Kroll SS, Reece GP, Miller MJ, Ainslie N, Halabi S, Balch CM. Incidence of autoimmune disease in patients after breast reconstruction with silicone gel implants versus autogenous tissue: a preliminary report.Ann Plast Surg 1993;31:1–6.
- Elkowitz A, Colen S, Slavin S, Seibert J, Weinstein M, Shaw W. Various methods of breast reconstruction after mastectomy: an economic comparison.Plast Reconstr Surg 1993;92:77–83.
- Donegan WL, Perez-Mesa CM, Watson FR. A biostatistical study of locally recurrent breast carcinoma.Surg Gynecol Obstet 1966;122:529–40.
- Gilliland MD, Larson DL, Copeland EM. Appropriate timing for breast reconstruction.Plast Reconstr Surg 1983;72:335–40.
- Slavin SA, Love SM, Goldwyn RM. Recurrent breast cancer following immediate reconstruction with myocutaneous flaps.Plast Reconstr Surg 1994;93:1191–1207.
- Auchincloss H. The nature of local recurrence following radical mastectomy.Cancer 1958;11:611.
- Georgiade GS, Riefkohl R, Cox E, McCarty KS, Seigler HF, Georgiade NG, Snowhite JC. Long-term clinical outcome of immediate reconstruction after mastectomy.Plast Reconstr Surg 1985;76:415–20.
- Georgiade GS. Immediate reconstruction of the breast following modified radical mastectomy for carcinoma of the breast.Clin Plast Surg 1984;11:383–8.
- Frazier TG, Noone RB. An objective analysis of immediate simultaneous reconstruction in the treatment of primary carcinoma of the breast.Cancer 1985;55:1202–5.
- Webster DJ, Mansel RE, Hughes LE. Immediate reconstruction of the breast after mastectomy. Is it safe?.Cancer 1984;53:1416–9.
- Mendelson EB. Evaluation of the postoperative breast.Rad Clin North Am 1992;30:107–38.
- Slavin SA, Local recurrence after mastectomy and breast reconstruction. In: Grotting JC, ed.Re-operative Aesthetic and Reconstructive Plastic Surgery. St. Louis: Quality Medical Publishing, 1995:1185–1206.
- Slavin SA, Howrigan PJ, Goldwyn RM. Pseudocyst formation after rectus flap breast reconstruction: diagnosis and treatment.Plast Reconstr Surg 1989;83:670–5.
- Puckett CL. Mammograms of the reconstructed breast.Plast Reconstr Surg 1991;88:482–3.
- Delaney G, Ung O, Cahill S, Bilous M, Boyages J. Ductal carcinoma in situ. Part 2: Treatment.Aust N Z J Surg 1997;67:157–65.
- Jacquemier J, Kurtz JM, Amalric R, Brandone H, Ayme Y, Spitalier JM. An assessment of extensive intraductal component as a risk factor for local recurrence after breast-conserving therapy.Br J Cancer 1990;61:873–6.
- Fisher ER, Costantino J, Fisher B, Palekar AS, Redmond C, Mamounas E. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) Protocol B-17. Intraductal carcinoma (ductal carcinoma in situ).Cancer 1995;756:1310–9.
- Cutuli B, Teissier E, Piat JM, Janser JC, Renaud R, Rodier JF, Jung GM. Radical surgery and conservative treatment of ductal carcinoma in situ of the breast.Eur J Cancer 1992;28:649–54. CrossRef
- Zafrani B, Vielh P, Fourquet A, Mosseri V, Durand JC, Salmon RJ, Vilcoq JR. Conservative treatment of early breast cancer: prognostic value of the ductal in situ component and other pathological variables on local control and survival. Long-term results.Eur J Cancer Clin Oncol 1989;25:1645–50. CrossRef
- Silverstein MJ, Lagios MD. Use of predictors of recurrence to plan therapy for DCIS of the breast.Oncology 1997;11:393–406, 409–415.
- Price P, Sinnett HD, Gusterson B, Walsh G, A'Hern RP, McKinna JA. Duct carcinoma in situ: predictors of local recurrence and progression in patients treated by surgery alone.Br J Cancer 1990;61:869–72.
- Solin LJ, Recht A, Fourquet A, et al. Ten-year results of breast-conserving conserving surgery and definitive irradiation for intraductal carcinoma (ductal carcinoma in situ) of the breast.Cancer 1991;68:2337–44.
- Silverstein MJ, Cohlan BF, Gierson ED, et al. Duct carcinoma in situ: 227 cases without microinvasion.Eur J Cancer 1992;28:630–44.
- Kroll SS, Schusterman MA, Tadjalli HE, Singletary SE, Ames FC. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy.Ann Surg Oncol 1997;4:193–7.
- Carlson GW, Bostwick J 3rd, Styblo TM, Moore B, Bried JT, Murray DR, Wood WC. Skin-sparing mastectomy. Oncologic and reconstructive considerations.Ann Surg 1997;225:570–8. CrossRef
- Dowden RV. Mammography after implant breast reconstruction.Plast Reconstr Surg 1991;1:119–121.
- Mund D, Wolfson P, Gorczyca DP, Fu YS, Love SM, Bassett LW. Mammographically detected recurrent nonpalpable carcinoma developing in a transverse rectus abdominis myocutaneous flap.Cancer 1994;74:2804–7.
- Is mammography useful in screening for local recurrences in patients with TRAM flap breast reconstruction after mastectomy for multifocal DCIS?
Annals of Surgical Oncology
Volume 5, Issue 5 , pp 456-463
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Breast cancer
- Local recurrence
- Ductal carcinoma in situ
- Skin-sparing mastectomy
- Industry Sectors
- Author Affiliations
- 1. From the Division of Surgical Oncology, University of Michigan Medical Center, Ann Arbor, Michigan
- 2. Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan
- 3. the Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
- 4. the Plastic Surgery Section, University of Michigan Medical Center, Ann Arbor, Michigan
- 5. the Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan
- 6. the Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan