Skip to main content
SpringerLink
Log in

Presentation, treatment, and outcome of local recurrence after skin-sparing mastectomy and immediate breast reconstruction

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

Abstract

Background: The local recurrence (LR) rate with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) has been reported as comparable to the LR rate after conventional mastectomy. However, limited data are available on the prognostic significance and management of LR following SSM.

Methods: A prospective database maintained at the University of Texas M. D. Anderson Cancer Center identified 437 SSMs performed for 372 invasive T1/T2 breast cancers between 1986 and 1993.

Results: Twenty-three LRs were identified, with a LR rate of 6.2% (23/372). Twenty-two of these (96%) presented as palpable skin-flap masses. The median time to recurrence was 25 months (range, 3 to 98 months). Fourteen patients were treated with a combination of surgery and systemic therapy. Resection of the reconstructed breast was performed in only three patients. Complete local control of the recurrent disease was achieved in 17 patients (74%). Nine patients (39%) developed distant metastatic disease. At a median follow-up of 26 months, 14 of 23 patients (61%) are alive without evidence of disease, and 7 (30%) have died from breast cancer.

Conclusions: Because LR rate with SSM is low and likelihood of local control and survival is high, SSM and IBR is an acceptable treatment option for early stage breast cancer.

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

Similar content being viewed by others

References

  1. Moyer A, Salovey P. Psychosocial sequelae of breast cancer and its treatment.Annals of Behavioral Medicine 1996;18:110–25.

    Google Scholar 

  2. Kroll SS, Schusterman MA, Tadjalli HE, Singletary SE, Ames FC. Risk of recurrence after treatment of breast cancer with skin-sparing mastectomy.Ann Surg Oncol 1997;4:193–7.

    CAS  PubMed  Google Scholar 

  3. Carlson GW, Bostwick J, Styblo TM, Moore B, Bried JT, Murray DR, Wood WC. Skin-sparing mastectomy: oncologic and reconstructive considerations.Ann Surg 1997;225:570–8.

    Article  CAS  PubMed  Google Scholar 

  4. Toth BA, Lappert P. Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning.Plast Reconstr Surg 1991;87:1048–53.

    CAS  PubMed  Google Scholar 

  5. Fisher B, Montague E, Redmond C, Barton B, Borland D, Fisher E, Deutsch M. Comparison of radical mastectomy with alternative treatments for primary breast cancer.Cancer 1977;39:2827–39.

    CAS  PubMed  Google Scholar 

  6. Veronesi U, Sarcozzi R, DelVecchio M, Banfi A, Clemente C, DeLena M, Gallus G. Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast.N Engl J Med 1981;305:6–11.

    CAS  PubMed  Google Scholar 

  7. Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, Fisher E. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer.N Engl J Med 1985;312:665–73.

    CAS  PubMed  Google Scholar 

  8. Ames FC, Balch CM. Management of local and regional recurrence after breast-conserving treatment.Surg Clin North Am 1990;70:1115–25.

    CAS  PubMed  Google Scholar 

  9. Gilliland MD, Barton RM, Copeland EM. The implications of local recurrence of breast cancer as the first site of therapeutic failure.Ann Surg 1983;197:284–7.

    CAS  PubMed  Google Scholar 

  10. Mora EM, Singletary SE, Buzdar AU, Johnston DA. Aggressive therapy for locoregional recurrence after mastectomy in stage II and III breast cancer patients.Ann Surg Oncol 1996;3:162–8.

    CAS  PubMed  Google Scholar 

  11. Willner J, Kiricuta IC, Kolbl O. Locoregional recurrence of breast cancer following mastectomy: always a fatal event? Results of a univariate and multivariate analysis.Int J Radiat Oncol Biol Phys 1997;37:853–63.

    Article  CAS  PubMed  Google Scholar 

  12. Beck TM, Hart NE, Woodard DA. Local or regionally recurrent carcinoma of the breast: results of therapy in 121 patients.J Clin Oncol 1983;1:400–5.

    CAS  PubMed  Google Scholar 

  13. Andry G, Suciu S, Vico P. Locoregional recurrences after 649 modified radical mastectomies: incidence and significance.Eur J Surg Oncol 1989;15:476–85.

    CAS  PubMed  Google Scholar 

  14. Borner M, Bacchi M, Goldhirsch A, et al. First isolated locoregional recurrence following mastectomy for breast cancer: results of a phase III multicenter study comparing systemic treatment with observation after excision and radiation.J Clin Oncol 1994;12:2071–7.

    CAS  PubMed  Google Scholar 

  15. Toonkel LM, Fix I, Jacobson LH, Wallach CB. The significance of local recurrence of carcinoma of the breast.Int J Radiat Oncol Biol Phys 1983;9:33–9.

    CAS  PubMed  Google Scholar 

  16. Barton FE, English JM, Kingsley WB, Fietz M. Glandular excision in total glandular mastectomy and modified radical mastectomy: a comparison.Plast Reconstr Surg 1991;88:389–92.

    PubMed  Google Scholar 

  17. Hunt KK, Baldwin BJ, Strom EA, Ames FC, McNeese MD, Kroll SS, Singletary SE. Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction.Ann Surg Oncol 1997;4:377–84.

    Article  CAS  PubMed  Google Scholar 

  18. Osborne MP, Simmons RM. Salvage surgery for recurrence after breast conservation.World J Surg 1994;18:93–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

    Stephen S. Kroll MD

  2. Dept. of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 106, 77030, Houston, TX

    Lisa A. Newman MD, Henry M. Kuerer MD, PhD, Kelly K. Hunt MD, Frederick C. Ames MD, Merrick I. Ross MD, Barry W. Feig MD & S. Eva Singletary MD

Authors
  1. Lisa A. Newman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henry M. Kuerer MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kelly K. Hunt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen S. Kroll MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frederick C. Ames MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Merrick I. Ross MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Barry W. Feig MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Eva Singletary MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Newman, L.A., Kuerer, H.M., Hunt, K.K. et al. Presentation, treatment, and outcome of local recurrence after skin-sparing mastectomy and immediate breast reconstruction. Annals of Surgical Oncology 5, 620–626 (1998). https://doi.org/10.1007/BF02303832

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02303832

Key Words

Search

Navigation