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Breast Cancer Recurrence following Prosthetic, Postmastectomy Reconstruction: Incidence, Detection, and Treatment

McCarthy, Colleen M. M.D., M.S.; Pusic, Andrea L. M.D., M.H.S.; Sclafani, Lisa M.D.; Buchanan, Claire M.D.; Fey, Jane V. M.P.H.; Disa, Joseph J. M.D.; Mehrara, Babak J. M.D.; Cordeiro, Peter G. M.D.

Plastic and Reconstructive Surgery: February 2008 - Volume 121 - Issue 2 - p 381-388
doi: 10.1097/01.prs.0000298316.74743.dd
BREAST: ORIGINAL ARTICLES
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Background: The purpose of this study was to evaluate the influence of prosthetic reconstruction on the incidence, detection, and management of locoregional recurrence following mastectomy for invasive breast cancer.

Methods: A matched retrospective cohort study was performed. Only patients with invasive breast cancer who had 2 years or more of follow-up and/or patients who had recurrence within 2 years of their primary cancer were included.

Results: In total, 618 patients who underwent mastectomy for invasive breast cancer from 1995 until 1999 were evaluated. Three hundred nine patients who had immediate, tissue expander/implant reconstruction were matched to 309 women who underwent mastectomy alone on the basis of age (±5 years) and breast cancer stage (I, II, or III). The incidence of locoregional recurrence following mastectomy was 6.8 percent in patients who had reconstruction and 8.1 percent in patients who had mastectomy alone (log rank p = 0.6015). Median time to detection of a locoregional recurrence was 2.3 years (range, 0.1 to 7.2 years) in the reconstructed cohort and 1.9 years (range, 0.1 to 8.8 years) in the nonreconstructed cohort (p = 0.733). Permanent implants were removed following infection in one patient and patient request in two.

Conclusions: These results suggest that there is no difference in the incidence of locoregional recurrence in breast cancer patients who undergo immediate, tissue expander/implant reconstruction compared with those patients who do not have reconstruction. Prosthetic breast reconstruction does not appear to hinder detection of locoregional cancer recurrence. In the majority of patients, management of locoregional recurrence does not necessitate removal of a permanent prosthesis.

New York, N.Y.

From the Plastic and Reconstructive Surgery and Breast Surgery Services, Department of Surgery, Memorial Sloan-Kettering Cancer Center.

Received for publication December 11, 2006; accepted March 22, 2007.

Presented at the 74th Annual Scientific Meeting of the American Society of Plastic Surgeons, in Chicago, Illinois, September 24 through 28, 2005.

Colleen M. McCarthy, M.D., M.S., Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room MRI-1007, New York, N.Y. 10021, mccarthc@mskcc.org

Disclosure:None of the authors has a financial interest in any of the devices, products, or drugs mentioned in this article.

©2008American Society of Plastic Surgeons