Esthetic reconstruction after mastectomy for inflammatory breast cancer: Is it worthwhile?

Background: Because inflammatory breast cancer (IBC) has been viewed as a m alignancy with a poor likelihood of longterm survival, few women have been offered esthetic reconstruction after mastectomy for IBC, Recent advances i n multimodality therapy have improved the outcomes for women with this dise ase. The purpose of this review was to assess the results of esthetic breas t reconstruction in the population with IBC, Study Design: Review of medical records at the City of Hope National Medica l Center for the 10-year period ending in May 1997, revealed 23 women who u nderwent elective esthetic breast reconstruction after mastectomy for IBC, The records of these patients were reviewed retrospectively. Patients requi ring reconstruction for large surgical chest wall defects were not included in the review. Results: Treatment for IBC included mastectomy in all patients, chemotherap y in 22, and chest wall radiation therapy in 14. Immediate reconstruction w as performed at the rime of mastectomy (n = 14) or was delayed (n = 9). The types of reconstruction included transverse rectus abdominis musculocutane ous flap (n = 18), latissimus dorsi nap (n = 2), or prosthetic mammary impl ant reconstruction (n = 3). Seven women chose to undergo additional reconst ruction procedures (ie, nipple reconstruction) after their initial reconstr uction. With a median followup of 44 months for survivors, 16 patients deve loped recurrence after reconstruction. Of these, 6 were local recurrences a nd 10 were distant failures. Seven patients are currently alive with no evi dence of disease, 4 are currently alive with disease, and 12 have died as a result of breast cancer. The median disease-free survival after reconstruc tion was 19 months. The median overall survival after reconstruction for al l patients was 22 months. The only negative predictor of survival was a pos itive surgical margin at mastectomy. Conclusions: The significant emotional and esthetic benefits of breast reco nstruction should be available to women with IBC, In light of the improving prognosis of IBC with current aggressive multimodality treatment, reconstr uctive procedures should be offered as part of comprehensive therapy. (J Am Coll Surg 2000; 190:304-309. (C) 2000 by the American College of Surgeons) .