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Locoregional Cancer Recurrence after Breast Reconstruction

Detection, Management, and Secondary Reconstructive Strategies

Mirzabeigi, Michael N., M.D.; Rhemtulla, Irfan A., M.D., M.S.; Mcdonald, Elizabeth S., M.D., Ph.D., F.S.B.I.; Sataloff, Dahlia M., M.D.; Kovach, Stephen J., M.D.; Wu, Liza C., M.D.; Serletti, Joseph M., M.D.; Kanchwala, Suhail, M.D.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 1322–1330
doi: 10.1097/PRS.0000000000005522
Breast: Original Articles
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Patient Safety CME

Background: Locoregional recurrence of the previously reconstructed breast poses a diagnostic and operative challenge. This study examines detection, management, and reconstructive strategies of locoregional recurrence following postmastectomy breast reconstruction.

Methods: A retrospective review of records was performed on patients treated within the health system for breast cancer from January of 2000 to July of 2014. Of these patients, descriptive factors and operative details were collected for those that developed locoregional recurrence. Subsequent reconstructive operations were also examined. Using a multidisciplinary team, a surveillance/management algorithm was generated.

Results: A total of 41 patients with locoregional recurrence were identified (mean time to recurrence, 4.6 years). Two- and 5-year survival following locoregional recurrence was 88 percent and 39 percent, respectively. Locoregional recurrence was found to occur in the following tissue planes: subcutaneous (27 percent), subcutaneous/pectoralis (24 percent), chest wall (37 percent), and axillary (12 percent). The most frequent method of detection was patient concern leading to examination. Older age at the time of locoregional recurrence (p = 0.028), increased time to recurrence/detection (p = 0.024), and chemotherapy before locoregional recurrence (p = 0.014) were associated with the need for a secondary salvage flap. Patients who experienced a subcutaneous recurrence were far less likely to undergo a secondary flap (p = 0.011). Factors associated with loss of the index reconstruction included lower body mass index (p = 0.009), pectoralis invasion (p = 0.05), and implant reconstruction (p = 0.03).

Conclusions: Detection and management of locoregional recurrence requires appropriate physical examination and imaging. Significant factors associated with failure to salvage the initial reconstruction included body mass index, plane of recurrence, and type of initial reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Patient Safety CME.

Philadelphia, Pa.

From the Division of Plastic Surgery, Department of Surgery, and the Departments of Radiology and Surgery, University of Pennsylvania Health System.

Received for publication January 18, 2018; accepted August 27, 2018.

Presented at the 2016 Annual Meeting of the American Society for Reconstructive Microsurgery, in Scottsdale, Arizona, January 16 through 19, 2016.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

By reading this article, you are entitled to claim one (1) hour of Category 2 Patient Safety Credit. ASPS members can claim this credit by logging in to PlasticSurgery.org Dashboard, clicking “Submit CME,” and completing the form.

Suhail Kanchwala, M.D., Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, South Pavilion, 14th Floor, 3400 Civic Center Boulevard, Philadelphia, Pa. 19104, suhail.kanchwala@uphs.upenn.edu

©2019American Society of Plastic Surgeons