RECURRENT BREAST-CANCER FOLLOWING IMMEDIATE RECONSTRUCTION WITH MYOCUTANEOUS FLAPS

As immediate breast reconstruction with rectus abdominis and Iatissimu s dorsi myocutaneous flaps has become a recognized technique for patie nts requiring mastectomy, concerns have arisen regarding the detection and treatment of locoregional recurrence of breast cancer. Because mo st recurrences develop in the residual native skin of the chest wall f ollowing a mastectomy, breast reconstruction procedures involving the placement of a subpectoral prosthesis are unlikely to interfere with p ostoperative cancer surveillance. Myocutaneous flaps, however, transpo se blocs of soft tissues into the mastectomy site. This study was done to evaluate the influence of a myocutaneous flap on the subsequent di agnosis and treatment of locoregional recurrence of breast cancer. Dat a were obtained from 161 patients with breast cancer who had immediate reconstruction with a myocutaneous flap between 1982 and 1990. Of the 161 patients reviewed, 120 had primary mastectomy with immediate reco nstruction; 41 patients had salvage mastectomy and immediate reconstru ction after failed conservative surgery and radiation therapy. Modifie d radical mastectomy was performed on all patients. Either a rectus ab dominis (n = 65) or latissimus dorsi (n = 97) myocutaneous flap breast reconstruction was performed. Recurrent tumor was observed in 17 of t he 161 patients reviewed (10.6 percent). Fourteen of the 17 recurrence s occurred in 120 patients having primary mastectomy and immediate rec onstruction for a rate of 11.7 percent; 3 of 41 patients (7.3 percent) who had salvage mastectomy and flap reconstruction developed recurren ces. Of the 17 recurrences, 6 patients were stage II, 10 were stage II I, and 1 was stage IV. All 17 patients who developed a recurrence had invasive breast cancer, with infiltrating and inflammatory tumors pred ominating. All locoregional recurrences of breast cancer developed wit hin the native skin and subcutaneous tissues adjacent to the mastectom y and flap reconstruction site. Recurrences were seen as rapidly as 2 weeks or as long as 3.8 years (mean 1.4) after the mastectomy and nap reconstruction. Overall mean follow-up for the entire group of 161 pat ients was 5.4 years. Thirteen of the 17patients (76.5 percent) develop ed distant metastases either concomitantly with the Iocoregional recur rence or within 4.3 years (mean 1.7). From an oncologic viewpoint, the technique of myocutaneous flap breast reconstruction with rectus abdo minis or latissimus dorsi flaps appears to be a safe one. An analysis of locoregional recurrence of breast cancer in patients undergoing pri mary mastectomy or salvage mastectomy with myocutaneous flap breast re construction did not show concealment by the flap of any recurrent tum or. There was no delay in diagnosis of any locoregional recurrence, no r was the treatment of a recurrence compromised or the patients' survi val adversely affected.