IS MAMMOGRAPHY USEFUL IN SCREENING FOR LOCAL RECURRENCES IN PATIENTS WITH TRAM FLAP BREAST RECONSTRUCTION AFTER MASTECTOMY FOR MULTIFOCAL DCIS

Background: Skin-sparing mastectomy with immediate transverse rectus a bdominis musculocutaneous (TRAM) flap reconstruction is being used mor e often for the treatment of breast cancer. Mammography is not used ro utinely to evaluate TRAM flaps in women who have undergone mastectomy. We have identified the potential value of its use in selected patient s. Methods and Results: We report on four women who manifested local r ecurrences in TRAM flaps after initial treatment for ductal carcinoma in situ (DCIS) or DCIS with microinvasion undergoing skin-sparing mast ectomy and immediate reconstruction All four patients presented with e xtensive, high-grade, multifocal DCIS that precluded breast conservati on. Three of four mastectomy specimens demonstrated tumor close to the surgical margin. Three of the four recurrences were detected by physi cal examination; the remaining local recurrence was documented by scre ening mammography. The recurrences had features suggestive of malignan cy on mammography. Conclusion: We conclude that all patients undergoin g mastectomy and TRAM reconstruction for extensive, multifocal DCIS sh ould undergo regular routine mammography of the reconstructed breast. Our experience with this subgroup of patients raises concern about the value of skin-sparing mastectomy with immediate reconstruction for th erapy. Adjuvant radiation therapy should be recommended for those pati ents with negative but close surgical margins.