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

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

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.

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Disclosures

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Author information

Authors and Affiliations

  1. Montpellier Institut du Sein, Clinique Clémentville, Montpellier, France

    Cécile Zinzindohoué MD, Pierre Bertrand MD, Aude Michel PhD & Emilie Monrigal MD

  2. Epsylon EA 4556 Laboratory “Dynamics of Human Abilities & Health Behaviors”, University Paul Valéry Montpellier 3, Montpellier, France

    Aude Michel PhD

  3. Polyclinique Urbain V, Avignon, France

    Bernard Miramand MD & Nicolas Sterckers MD

  4. Centre Léon Bérard, Lyon, France

    Christelle Faure MD

  5. Institut Claudius Regaud, Toulouse Cedex 3, France

    Hélène Charitansky MD

  6. Institut Du Cancer De Montpellier (ICM), Montpellier, France

    Marian Gutowski MD

  7. Institut Paoli Calmettes, Marseille, France

    Monique Cohen MD & Gilles Houvenaeghel MD, PhD

  8. Montpellier Institut du Sein, Clinique Saint Roch, Montpellier, France

    Frederic Trentini MD

  9. Centre Paul Papin, Angers, France

    Pedro Raro MD

  10. UPRES 2415, Montpellier, France

    Jean-Pierre Daures MD, PhD & Sandy Lacombe MA

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  1. Cécile Zinzindohoué MD
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  2. Pierre Bertrand MD
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Corresponding author

Correspondence to Cécile Zinzindohoué MD.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

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)

Fig. 1 continued

(B) 30 days after SSM. Supplementary material 2 (JPEG 120 kb)

Fig. 1 continued

(C) Final result 1 year after SSM and 2 lipofilling procedures. Supplementary material 3 (JPEG 97 kb)

Fig. 2

Final result of SSM with latissimus dorsi flap, periareolar symetrisation and lipofilling. (A) Preoperative mapping. Supplementary material 4 (JPEG 1,265 kb)

Fig. 2 continued

(B) Final result 1 year after SSM. Supplementary material 5 (JPEG 1,035 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)

Fig. 3 continued

(B) 10 days after surgery. Supplementary material 7 (JPEG 103 kb)

Fig. 3 continued

(C) Necrosis, 21 days after surgery. Supplementary material 8 (JPEG 108 kb)

Fig. 3 continued

(D) 45 days after surgery. Supplementary material 9 (JPEG 94 kb)

Fig. 3 continued

(E) Final result 1 year after surgery. Supplementary material 10 (JPEG 105 kb)

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Zinzindohoué, C., Bertrand, P., Michel, A. et al. A Prospective Study on Skin-Sparing Mastectomy for Immediate Breast Reconstruction with Latissimus Dorsi Flap After Neoadjuvant Chemotherapy and Radiotherapy in Invasive Breast Carcinoma. Ann Surg Oncol 23, 2350–2356 (2016). https://doi.org/10.1245/s10434-016-5146-y

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  • DOI: https://doi.org/10.1245/s10434-016-5146-y

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