Abstract
Objectives
To evaluate clinical and imaging features of cancer recurrence in reconstructed breasts following skin-sparing mastectomy (SSM) or nipple areolar skin-sparing mastectomy (NASSM).
Methods
This study was approved by our Institutional Review Board. In this retrospective study, we included patients with pathologically confirmed recurrent cancer who had transverse rectus abdominis myocutaneous (TRAM) flap reconstruction after SSM or NASSM and whose follow-up radiological studies were available. Each patient’s demographic data, imaging studies and clinical outcomes were reviewed. Two breast radiologists analysed the imaging findings of follow-up mammography, ultrasound and magnetic resonance imaging.
Results
Of the 964 patients, 16 (1.7 %) had local cancer recurrence. The average follow-up period until the detection was 31.1 months (range, 7–84 months). Fourteen (87.5 %) patients had recurrence on the skin or in subcutaneous fat. Of the 16 patients, recurrence was detected by breast self-examination in 13 (81.3 %) patients. Eight (50 %) lesions mimicked benign lesions. The other eight (50 %) lesions manifested various degree of suspicion for the malignancy.
Conclusions
Recurrent cancer after TRAM flap reconstruction following SSM and NASSM is often recognised by breast self-examination and mimics imaging findings of benign lesions. Therefore, meticulous physical examination and history-taking are important. Pathological confirmation is worthwhile even in the benign-appearing lesions.
Key Points
• Overview of clinical and imaging features of cancer recurrence in reconstructed breasts
• 50 % of recurred malignant lesions mimicking imaging findings of benign lesions
• Patients may benefit from thorough self-breast examination
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hidalgo DA, Borgen PJ, Petrek JA, Heerdt AH, Cody HS, Disa JJ (1998) Immediate reconstruction after complete skin-sparing mastectomy with autologous tissue. J Am Coll Surg 187:17–21
Disa JJ, Cordeiro PG, Heerdt AH, Petrek JA, Borgen PJ, Hidalgo DA (2003) Skin-sparing mastectomy and immediate autologous tissue reconstruction after whole-breast irradiation. Plast Reconstr Surg 111:118–124
Kroll SS, Khoo A, Singletary SE et al (1999) Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up. Plast Reconstr Surg 104:421–425
Slavin SA, Schnitt SJ, Duda RB et al (1998) Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg 102:49–62
Foster RD, Esserman LJ, Anthony JP, Hwang ES, Do H (2002) Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast carcinoma. Ann Surg Oncol 9:462–466
Carlson GW, Styblo TM, Lyles RH et al (2003) Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism? Ann Surg Oncol 10:108–112
Medina-Franco H, Vasconez LO, Fix RJ et al (2002) Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Ann Surg 235:814–819
American College of Radiology, BI-RADS Committee (2003) ACR BI-RADS breast imaging and reporting data system: breast imaging atlas, 4th edn. American College of Radiology, Reston
Langstein HN, Cheng MH, Singletary SE et al (2003) Breast cancer recurrence after immediate reconstruction: patterns and significance. Plast Reconstr Surg 111:712–720, discussion 721-712
Howard MA, Polo K, Pusic AL et al (2006) Breast cancer local recurrence after mastectomy and TRAM flap reconstruction: incidence and treatment options. Plast Reconstr Surg 117:1381–1386
Lee TJ, Hur WJ, Kim EK, Ahn SH (2012) Outcome of management of local recurrence after immediate transverse rectus abdominis myocutaneous flap breast reconstruction. Arch Plast Surg 39:376–383
Edeiken BS, Fornage BD, Bedi DG, Sneige N, Parulekar SG, Pleasure J (2003) Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis. Radiology 227:542–548
Handley RS (1964) The early spread of breast carcinoma and its bearing on operative treatment. Br J Surg 51:206–208
Turner-Warwick RT (1959) The lymphatics of the breast. Br J Surg 46:574–582
Suami H, Pan WR, Mann GB, Taylor GI (2008) The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol 15:863–871
Hogge JP, Robinson RE, Magnant CM, Zuurbier RA (1995) The mammographic spectrum of fat necrosis of the breast. Radiographics 15:1347–1356
Acknowledgements
The scientific guarantor of this publication is Hak Hee Kim. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study/observational, performed at one institution.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yoo, H., Kim, B.H., Kim, H.H. et al. Local recurrence of breast cancer in reconstructed breasts using TRAM flap after skin-sparing mastectomy: clinical and imaging features. Eur Radiol 24, 2220–2226 (2014). https://doi.org/10.1007/s00330-014-3214-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-014-3214-x