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Annals of Surgical Oncology

, Volume 23, Issue 7, pp 2350–2356 | Cite as

A Prospective Study on Skin-Sparing Mastectomy for Immediate Breast Reconstruction with Latissimus Dorsi Flap After Neoadjuvant Chemotherapy and Radiotherapy in Invasive Breast Carcinoma

  • Cécile Zinzindohoué
  • Pierre Bertrand
  • Aude Michel
  • Emilie Monrigal
  • Bernard Miramand
  • Nicolas Sterckers
  • Christelle Faure
  • Hélène Charitansky
  • Marian Gutowski
  • Monique Cohen
  • Gilles Houvenaeghel
  • Frederic Trentini
  • Pedro Raro
  • Jean-Pierre Daures
  • Sandy Lacombe
Reconstructive Oncology

Abstract

Background

Skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) is increasingly used in invasive breast cancer. However, adjuvant chemotherapy (CT) and radiotherapy (RT) can increase the rate of local complications.

Objective

The aim of this study was to assess the morbidity of SSM–IBR after neoadjuvant CT and RT.

Methods

A French prospective pilot study of women aged 18–75 years with invasive breast cancer requiring mastectomy after CT and RT. Reconstruction was performed using autologous latissimus dorsi flap with or without prosthesis. The primary endpoint was the skin necrosis rate within 6 months, while secondary endpoints included pathological complete response rate (pCR) and global morbidity.

Results

Among 94 patients included in this study, 83 were analyzed (mean age 45.2 ± 9.5 years, T1 23.6 %, T2 55.6 %, T3 18.1 %). All but one patient received anthracyclines and taxanes, and all patients received RT (49.3 ± 5.2 Gy) before SSM–IBR. Prostheses were used for IBR in 32 patients (mean volume 256 ± 73 mm3). Five patients had necrosis (≤2 cm2, 2–10 cm2 and >10 cm2, in three, one, and one cases, respectively), and they all recovered without revision surgery. Among 50 patients who underwent upfront mastectomy, 36 % achieved pCR.

Conclusions

SSM–IBR performed after CT and RT is safe, with an acceptable local morbidity rate. Long-term data are needed to evaluate recurrence rates.

Keywords

Skin Necrosis Immediate Breast Reconstruction Necrosis Rate Latissimus Dorsi Flap Transverse Rectus Abdominis Myocutaneous 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosures

None.

Supplementary material

10434_2016_5146_MOESM1_ESM.jpg (107 kb)
Fig. 1 Final result of SSM with latissimus dorsi flap and lipofilling in a patient with scar due to an initial attempt of breast conservative surgery. (A) After attempt of conservative surgery, chemotherapy, radiotherapy and before SSM. Supplementary material 1 (JPEG 106 kb)
10434_2016_5146_MOESM2_ESM.jpg (121 kb)
Fig. 1 continued (B) 30 days after SSM. Supplementary material 2 (JPEG 120 kb)
10434_2016_5146_MOESM3_ESM.jpg (97 kb)
Fig. 1 continued (C) Final result 1 year after SSM and 2 lipofilling procedures. Supplementary material 3 (JPEG 97 kb)
10434_2016_5146_MOESM4_ESM.jpg (1.2 mb)
Fig. 2 Final result of SSM with latissimus dorsi flap, periareolar symetrisation and lipofilling. (A) Preoperative mapping. Supplementary material 4 (JPEG 1,265 kb)
10434_2016_5146_MOESM5_ESM.jpg (1 mb)
Fig. 2 continued (B) Final result 1 year after SSM. Supplementary material 5 (JPEG 1,035 kb)
10434_2016_5146_MOESM6_ESM.jpg (101 kb)
Fig. 3 Evolution of necrosis and final result in a patient who had left SSM with latissimus dorsi flap and prosthesis, followed by symmetrisation with right augmentation implant. (A) Before surgery. Supplementary material 6 (JPEG 100 kb)
10434_2016_5146_MOESM7_ESM.jpg (104 kb)
Fig. 3 continued (B) 10 days after surgery. Supplementary material 7 (JPEG 103 kb)
10434_2016_5146_MOESM8_ESM.jpg (109 kb)
Fig. 3 continued (C) Necrosis, 21 days after surgery. Supplementary material 8 (JPEG 108 kb)
10434_2016_5146_MOESM9_ESM.jpg (95 kb)
Fig. 3 continued (D) 45 days after surgery. Supplementary material 9 (JPEG 94 kb)
10434_2016_5146_MOESM10_ESM.jpg (106 kb)
Fig. 3 continued (E) Final result 1 year after surgery. Supplementary material 10 (JPEG 105 kb)

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Cécile Zinzindohoué
    • 1
  • Pierre Bertrand
    • 1
  • Aude Michel
    • 1
    • 2
  • Emilie Monrigal
    • 1
  • Bernard Miramand
    • 3
  • Nicolas Sterckers
    • 3
  • Christelle Faure
    • 4
  • Hélène Charitansky
    • 5
  • Marian Gutowski
    • 6
  • Monique Cohen
    • 7
  • Gilles Houvenaeghel
    • 7
  • Frederic Trentini
    • 8
  • Pedro Raro
    • 9
  • Jean-Pierre Daures
    • 10
  • Sandy Lacombe
    • 10
  1. 1.Montpellier Institut du SeinClinique ClémentvilleMontpellierFrance
  2. 2.Epsylon EA 4556 Laboratory “Dynamics of Human Abilities & Health Behaviors”University Paul Valéry Montpellier 3MontpellierFrance
  3. 3.Polyclinique Urbain VAvignonFrance
  4. 4.Centre Léon BérardLyonFrance
  5. 5.Institut Claudius RegaudToulouse Cedex 3France
  6. 6.Institut Du Cancer De Montpellier (ICM)MontpellierFrance
  7. 7.Institut Paoli CalmettesMarseilleFrance
  8. 8.Montpellier Institut du SeinClinique Saint RochMontpellierFrance
  9. 9.Centre Paul PapinAngersFrance
  10. 10.UPRES 2415MontpellierFrance

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