Feasibility of immediate breast reconstruction for locally advanced breastcancer

Background: Immediate breast reconstruction (IBR) has been considered contr aindicated for patients with locally advanced breast cancer (LABC). Our goa l was to determine whether IBR resulted in delayed postoperative chemothera py, increased postoperative complications, or increased risk of recurrent d isease. Methods: A prospective database of 540 modified radical mastectomies perfor med with IBR between 1990 and 1993 identified 50 patients with LABC. Postop erative management and outcome were compared to that of 72 patients undergo ing modified radical mastectomy without IBR treated on a standardized LABC protocol using preoperative chemotherapy, postoperative chemotherapy, and r adiotherapy during the same time period. Results: Results were evaluated by chi(2) analysis. The median ages for the patients with IBR versus those not undergoing IBR were 44 and 46 years, re spectively. The stage distribution for the IBR patients versus patients not undergoing IBR was as follows: IIB, 46% versus 17%; IIIA, 44% versus 39%; and IIIB, 10% versus 44%. The types of IBR were transverse rectus abdominis myocutaneous (TRAM) flap (68%), latissimus dorsi flap (2%), and implants ( 30%). Chemotherapy was given to all DBR patients: 24% preoperatively and 96 % postoperatively. Radiotherapy was used in 40%. Four postoperative complic ations (8%) necessitated prolongation of hospitalization, including two pat ients requiring surgical debridement for partial flap loss; there were no c omplete flap losses. The incidences of major and minor wound complications in the group not undergoing IBR were 7% and 4%, respectively. Of the 15 pat ients receiving implant reconstruction, 7 (47%) required subsequent implant removal because of contractures or infections. The median interval between surgery and postoperative chemotherapy was 35 days for the IBR patients an d 21 days for the patients not undergoing IBR. This difference was marginal ly significant (P = .05). With a median follow-up of 58.4 months, no signif icant differences in local or distant relapse rates were detected. Conclusions: IBR can be performed with low morbidity in patients with LABC. Use of autogenous tissue is preferable because of poor results with implan ts. IBR is associated with somewhat longer intervals to resumption of posto perative chemotherapy, but this does not appear to be clinically significan t-the local and distant relapse rates are similar for LABC patients undergo ing modified radical mastectomy with or without IBR.