Immediate Breast and Chest Wall Reconstruction for Advanced Breast Cancer

Yang, Jung Dug; Kim, Hak Tae; Chung, Ho Yun; Cho, Byung Chae; Choi, Kang Young; Lee, Jung Hun; Lee, Jeong Woo; Park, Ho Yong; Jung, Jin Hyang; Chae, Yee Soo

Abstract

PURPOSE
Advanced breast cancer traditionally has been perceived as a contraindication to immediate breast reconstruction, because of concerns regarding adjuvant treatment delays and the cosmetic effects of radiotherapy to breast reconstruction, so delayed reconstruction is usually preferred in advanced breast cancer patients undergoing mastectomy. However, with the improved outcome using multimodality therapy, consisting of perioperative chemotherapy and radiotherapy, immediate breast reconstruction is now being performed as surgical option for selected advanced breast cancer patients. Additionally, advanced breast cancer patients may be needed soft tissue coverage of an extensive skin and soft tussue defect after mastectomy. Current authors have experienced several types of immediate breast and chest wall reconstruction for advanced breast cancer.
METHODS
From December of 2007 to June of 2009, 14 women performed for immediate breast and chest wall reconstruction for advanced breast cancer. They had been treated with neoadjuvant chemotherapy or chemoradiotherapy followed by modified radical mastectomy or radical mastectomy. Four different techniques were used immediate breast and chest wall reconstruction, which are pedicled TRAM flap(4 cases), extended LD flap with STSG(3 cases), thoracoabdominal flap(4 cases) and thoracoepigastric flap(3 cases).
RESULTS
The mean age was 53 years and mean follow up period was 9 months. Patients' oncologic status ranged stage IIIa to stage IV. Two patients had major complications: partial flap necrosis of TRAM flap and one distal necrosis of thoracoabdominal flap. Three patients with stage IV disease died from metastases.
CONCLUSION
The result of this study suggests that immediate breast and chest wall reconstruction can be considered as surgical option for advanced breast cancer. But we need long term follow up and large prospective studies for recurrence and survival.