Skip to main content

Advertisement

SpringerLink
Log in

Breast Reconstruction in the Setting of Stage 4 Breast Cancer: Is It Worthwhile?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The role of reconstruction after primary tumor surgery for metastatic breast cancer remains controversial. This report describes the outcomes for patients undergoing mastectomy with and without reconstruction in the setting of de novo stage 4 breast cancer.

Methods

Using a prospectively maintained institutional breast surgery database, this study identified all patients who presented with de novo stage 4 breast cancer from January 2008 to December 2018. Patients were included if they had undergone mastectomy with or without reconstruction. Patient, surgical characteristics, and survival outcomes were abstracted and analyzed.

Results

The study identified 29 patients: 8 patients (28%) who underwent reconstruction (R) and 21 patients (72%) who did not (NR). Complete clinical response to induction systemic therapy was more frequent among patients in the R group than among those in the NR group for the primary disease (50% in R, 5% in NR), and to a lesser degree for distant disease (63% in R, 39% in NR). No difference in complication rates between the two groups was identified [n = 1 (13%) in R; n = 2 (10%) in NR; p = 1.0]. Overall survival from surgery was longer in the R group (100% at 2 and 5 years) than in the NR group [85%; 95% confidence interval (CI), 68–100% at 2 years vs 50%; 95% CI 27–91% at 5 years] (p = 0.046).

Conclusion

Breast reconstruction after mastectomy may be reasonable to consider for appropriately selected patients with de novo stage 4 breast cancer who have excellent responses to systemic therapy and anticipated durable survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wu SG, Li H, Tang LY, et al. The effect of distant metastases sites on survival in de novo stage-IV breast cancer: a SEER database analysis. Tumour Biol. 2017;39:1010428317705082.

    PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA: Cancer J Clin. 2018;68:7–30.

  3. Weiss A, Chu CK, Lin H, et al. Reconstruction in the metastatic breast cancer patient: results from the National Cancer Database. Ann Surg Oncol. 2018;25:3125–33.

    Article  Google Scholar 

  4. Caswell-Jin JL, Plevritis SK, Tian L, et al. Change in survival in metastatic breast cancer with treatment advances: meta-analysis and systematic review. JNCI Cancer Spectr. 2018;2:pky062.

    Article  Google Scholar 

  5. Thomas A, Khan SA, Chrischilles EA, Schroeder MC. Initial surgery and survival in stage IV breast cancer in the United States, 1988–2011. JAMA Surg. 2016;151:424–31.

    Article  Google Scholar 

  6. Gnerlich J, Dueker JM, Jeffe DB, Deshpande AD, Thompson S, Margenthaler JA. Patient and tumor characteristics associated with primary tumor resection in women with stage IV breast cancer: analysis of 1988–2003 SEER data. Breast J. 2008;14:538–42.

    Article  Google Scholar 

  7. Lu S, Wu J, Fang Y, et al. The impact of surgical excision of the primary tumor in stage IV breast cancer on survival: a meta-analysis. Oncotarget. 2017;9:11816–23.

    Article  Google Scholar 

  8. Warschkow R, Guller U, Tarantino I, et al. Improved survival after primary tumor surgery in metastatic breast cancer: a propensity-adjusted, population-based SEER trend analysis. Ann Surg. 2016;263:1188–98.

    Article  Google Scholar 

  9. Lane WO, Thomas SM, Blitzblau RC, et al. Surgical resection of the primary tumor in women with de novo stage IV breast cancer: contemporary practice patterns and survival analysis. Ann Surg. 2019;269:537–44.

    Article  Google Scholar 

  10. Badwe R, Hawaldar R, Nair N, et al. Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial. Lancet Oncol. 2015;16:1380–8.

    Article  Google Scholar 

  11. Soran A, Ozmen V, Ozbas S, et al. Randomized trial comparing resection of primary tumor with no surgery in stage IV breast cancer at presentation: protocol MF07-01. Ann Surg Oncol. 2018;25:3141–9.

    Article  Google Scholar 

  12. Durrant CA, Khatib M, Macneill F, James S, Harris P. Mastectomy and reconstruction in stage IV breast cancer: a survey of UK breast and plastic surgeons. Breast Edinburgh Scotland. 2011;20:373–9.

    Article  CAS  Google Scholar 

  13. Dauplat J, Kwiatkowski F, Rouanet P, et al. Quality of life after mastectomy with or without immediate breast reconstruction. Br J Surg. 2017;104:1197–206.

    Article  CAS  Google Scholar 

  14. Fischer JP, Fox JP, Nelson JA, Kovach SJ, Serletti JM. A longitudinal assessment of outcomes and healthcare resource utilization after immediate breast reconstruction: comparing implant- and autologous-based breast reconstruction. Ann Surg. 2015;262:692–9.

    Article  Google Scholar 

  15. Chen H, Zhang M, Wang M, Zhang P, Bai F, Wu K. Immediate breast reconstruction in de novo metastatic breast cancer: an analysis of 563 cases based on the SEER database. Clin Breast Cancer. 2019;19:e135–41.

    Article  Google Scholar 

  16. Amin MB, Edge SB, Greene FL, et al (eds). AJCC (American Joint Committee on Cancer). Cancer Staging Manual. 8th ed. 3rd printing. Springer, Chicago, 2018.

  17. Wolff AC, Hammond MEH, Allison KH, et al. Human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline-Focused Update. J Clin Oncol. 2018;36:2105–22.

    Article  CAS  Google Scholar 

  18. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. JNCI J Natl Cancer Instit. 2000;92:205–16.

    Article  CAS  Google Scholar 

  19. Behnam AB, Nguyen D, Moran SL, Serletti JM. TRAM flap breast reconstruction for patients with advanced breast disease. Ann Plast Surg. 2003;50:567–71.

    Article  Google Scholar 

  20. Aliu O, Zhong L, Chetta MD, et al. Comparing health care resource use between implant and autologous reconstruction of the irradiated breast: a national claims-based assessment. Plast Reconstr Surg. 2017;139:1224e–31e.

    Article  CAS  Google Scholar 

  21. Neuman HB, Morrogh M, Gonen M, Van Zee KJ, Morrow M, King TA. Stage IV breast cancer in the era of targeted therapy: does surgery of the primary tumor matter? Cancer. 2010;116:1226–33.

    Article  Google Scholar 

  22. Olson EM, Najita JS, Sohl J, et al. Clinical outcomes and treatment practice patterns of patients with HER2-positive metastatic breast cancer in the post-trastuzumab era. Breast Edinburgh Scotland. 2013;22:525–31.

    Article  Google Scholar 

  23. Bafford AC, Burstein HJ, Barkley CR, et al. Breast surgery in stage IV breast cancer: impact of staging and patient selection on overall survival. Breast Cancer Res Treat. 2009;115:7–12.

    Article  Google Scholar 

  24. Blanchard DK, Shetty PB, Hilsenbeck SG, Elledge RM. Association of surgery with improved survival in stage IV breast cancer patients. Ann Surg. 2008;247:732–8.

    Article  Google Scholar 

  25. Nano MT, Gill PG, Kollias J, Bochner MA, Malycha P, Winefield HR. Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg. 2005;75:940–7.

    Article  Google Scholar 

  26. Elswick SM, Harless CA, Bishop SN, et al. Prepectoral implant-based breast reconstruction with postmastectomy radiation therapy. Plast Reconstr Surg. 2018;142:1–12.

    Article  CAS  Google Scholar 

  27. Ho AY, Hu ZI, Mehrara BJ, Wilkins EG. Radiotherapy in the setting of breast reconstruction: types, techniques, and timing. Lancet Oncol. 2017;18:e742–53.

    Article  Google Scholar 

  28. Shammas RL, Ren Y, Thomas SM, Hollenbeck ST, Greenup RA, Blitzblau RC. Immediate breast reconstruction allows for the timely initiation of post-mastectomy radiation therapy. Plast Reconstr Surg. 2019;144:347e–57e.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Malke Asaad MD, Jesse Meaike MD, Jorys Martinez-Jorge MD, Nho Tran MD & Minh-Doan Nguyen MD, PhD

  2. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    Jennifer Yonkus MD, Tanya Hoskin MS, Tina Hieken MD, Judy Boughey MD & Amy C. Degnim MD

Authors
  1. Malke Asaad MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jesse Meaike MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Yonkus MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tanya Hoskin MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tina Hieken MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jorys Martinez-Jorge MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nho Tran MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Minh-Doan Nguyen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Judy Boughey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Amy C. Degnim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy C. Degnim MD.

Ethics declarations

Disclosure

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Asaad, M., Meaike, J., Yonkus, J. et al. Breast Reconstruction in the Setting of Stage 4 Breast Cancer: Is It Worthwhile?. Ann Surg Oncol 27, 4730–4739 (2020). https://doi.org/10.1245/s10434-020-08879-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08879-8

Search

Navigation