Annals of Surgical Oncology

, Volume 6, Issue 7, pp 671–675

Feasibility of Immediate Breast Reconstruction for Locally Advanced Breast Cancer

  • Lisa A. Newman
  • Henry M. Kuerer
  • Kelly K. Hunt
  • Frederick C. Ames
  • Merrick I. Ross
  • Richard Theriault
  • Nancy Fry
  • Stephen S. Kroll
  • Geoffrey L. Robb
  • S. Eva Singletary
Original Article

Abstract

Background: Immediate breast reconstruction (IBR) has been considered contraindicated for patients with locally advanced breast cancer (LABC). Our goal was to determine whether IBR resulted in delayed postoperative chemotherapy, increased postoperative complications, or increased risk of recurrent disease.

Methods: A prospective database of 540 modified radical mastectomies performed with IBR between 1990 and 1993 identified 50 patients with LABC. Postoperative management and outcome were compared to that of 72 patients undergoing modified radical mastectomy without IBR treated on a standardized LABC protocol using preoperative chemotherapy, postoperative chemotherapy, and radiotherapy during the same time period.

Results: Results were evaluated by χ2 analysis. The median ages for the patients with IBR versus those not undergoing IBR were 44 and 46 years, respectively. The stage distribution for the IBR patients versus patients not undergoing IBR was as follows: IIB, 46% versus 17%; IIIA, 44% versus 39%; and IIIB, 10% versus 44%. The types of IBR were transverse rectus abdominis myocutaneous (TRAM) flap (68%), latissimus dorsi flap (2%), and implants (30%). Chemotherapy was given to all IBR patients: 24% preoperatively and 96% postoperatively. Radiotherapy was used in 40%. Four postoperative complications (8%) necessitated prolongation of hospitalization, including two patients requiring surgical debridement for partial flap loss; there were no complete flap losses. The incidences of major and minor wound complications in the group not undergoing IBR were 7% and 4%, respectively. Of the 15 patients receiving implant reconstruction, 7 (47%) required subsequent implant removal because of contractures or infections. The median interval between surgery and postoperative chemotherapy was 35 days for the IBR patients and 21 days for the patients not undergoing IBR. This difference was marginally significant (P 5.05). With a median follow-up of 58.4 months, no significant differences in local or distant relapse rates were detected.

Conclusions: IBR can be performed with low morbidity in patients with LABC. Use of autogenous tissue is preferable because of poor results with implants. IBR is associated with somewhat longer intervals to resumption of postoperative chemotherapy, but this does not appear to be clinically significant—the local and distant relapse rates are similar for LABC patients undergoing modified radical mastectomy with or without IBR.

Key Words

Locally advanced breast cancer Immediate breast reconstruction 

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Copyright information

© The Society of Surgical Oncology, Inc. 1999

Authors and Affiliations

  • Lisa A. Newman
    • 1
  • Henry M. Kuerer
    • 4
  • Kelly K. Hunt
    • 1
  • Frederick C. Ames
    • 1
  • Merrick I. Ross
    • 1
  • Richard Theriault
    • 2
  • Nancy Fry
    • 2
  • Stephen S. Kroll
    • 3
  • Geoffrey L. Robb
    • 3
  • S. Eva Singletary
    • 1
    • 5
  1. 1.Surgical OncologySan Francisco
  2. 2.Medical Breast OncologySan Francisco
  3. 3.Plastic and Reconstructive SurgeryThe University of Texas M. D. Anderson Cancer CenterHouston
  4. 4.Department of SurgeryUniversity of California San FranciscoSan Francisco
  5. 5.Dept. of Surgical OncologyThe University of Texas M. D. Anderson Cancer CenterHouston

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