Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Outcome of Management of Local Recurrence after Immediate Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction

  • Lee, Taik Jong (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hur, Wu Jin (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Eun Key (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Sei Hyun (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2012.03.14
  • Accepted : 2012.06.05
  • Published : 2012.07.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background No consensus has been reached regarding the outcome of management of local recurrence after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. This study demonstrated the presentation, management, and outcomes of local recurrence after immediate TRAM breast reconstruction. Methods A comparison was conducted among 1,000 consecutive patients who underwent immediate breast reconstruction with a pedicled TRAM flap (TRAM group) and 3,183 consecutive patients who underwent only modified radical mastectomy without reconstruction (MRM group) from January 2001 to December 2009. The presentation, treatment, and outcome including aesthetics and overall survival rate were analyzed. Results Local recurrences occurred in 18 (1.8%) patients (TRAM-LR group) who underwent TRAM breast reconstruction and 38 (1.2%) patients (MRM-LR group) who underwent MRM only (P=0.1712). Wide excision was indicated in almost all the local recurrence cases. Skin graft was required in 4 patients in the MRM-LR group, whereas only one patient required a skin graft to preserve the mound shape in the TRAM-LR group. The breast mound was maintained in all 17 patients that survived in the TRAM-LR group even after wide excision. The overall survival rate was 94.4% in the TRAM-LR group and 65.8% in the MRM-LR group (P=0.276). Conclusions Local recurrence after immediate TRAM flap breast reconstruction could be detected without delay and managed effectively by multiple modalities without reducing overall survival rates. Breast mound reconstruction with soft autologous tissue allowed for primary closure in most of the cases. In all of the patients who survived, the contour of their reconstructed breast remained.

Keywords

References

  1. Schain WS, Wellisch DK, Pasnau RO, et al. The sooner the better: a study of psychological factors in women undergoing immediate versus delayed breast reconstruction. Am J Psychiatry 1985;142:40-6. https://doi.org/10.1176/ajp.142.1.40
  2. Ahn SH, Yoo KY; Korean Breast Cancer Society. Chronological changes of clinical characteristics in 31,115 new breast cancer patients among Koreans during 1996-2004. Breast Cancer Res Treat 2006;99:209-14. https://doi.org/10.1007/s10549-006-9188-x
  3. Disa JJ, Cordeiro PG, Heerdt AH, et al. Skin-sparing mastectomy and immediate autologous tissue reconstruction after whole-breast irradiation. Plast Reconstr Surg 2003;111: 118-24. https://doi.org/10.1097/00006534-200301000-00020
  4. Kim HJ, Park EH, Lim WS, et al. Nipple areola skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction is an oncologically safe procedure: a single center study. Ann Surg 2010;251: 493-8. https://doi.org/10.1097/SLA.0b013e3181c5dc4e
  5. Toth BA, Forley BG, Calabria R. Retrospective study of the skin-sparing mastectomy in breast reconstruction. Plast Reconstr Surg 1999;104:77-84. https://doi.org/10.1097/00006534-199907000-00011
  6. Newman LA, Kuerer HM, Hunt KK, et al. Presentation, treatment, and outcome of local recurrence afterskin-sparing mastectomy and immediate breast reconstruction. Ann Surg Oncol 1998;5:620-6. https://doi.org/10.1007/BF02303832
  7. Howard MA, Polo K, Pusic AL, et al. Breast cancer local recurrence after mastectomy and TRAM flap reconstruction: incidence and treatment options. Plast Reconstr Surg 2006;117:1381-6. https://doi.org/10.1097/01.prs.0000208116.86765.4a
  8. Gerber B, Krause A, Reimer T, et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 2003;238:120-7.
  9. Simmons RM, Fish SK, Gayle L, et al. Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies. Ann Surg Oncol 1999;6: 676-81. https://doi.org/10.1007/s10434-999-0676-1
  10. Medina-Franco H, Vasconez LO, Fix RJ, et al. Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Ann Surg 2002;235:814-9. https://doi.org/10.1097/00000658-200206000-00008
  11. Foster RD, Esserman LJ, Anthony JP, et al. Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast carcinoma. Ann Surg Oncol 2002;9:462-6. https://doi.org/10.1007/BF02557269
  12. Kroll SS, Khoo A, Singletary SE, et al. Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up. Plast Reconstr Surg 1999;104:421-5. https://doi.org/10.1097/00006534-199908000-00015

Cited by

  1. Reconstruction of Unexpected Huge Chest Wall Defect after Recurrent Breast Cancer Excision Using a TRAM Flap Combined with Partial Latissimus Dorsi Muscle Flap vol.40, pp.1, 2013, https://doi.org/10.5999/aps.2013.40.1.76
  2. Can intensity‐modulated radiation therapy spare the central flapped area while encompassing the target volume in radiotherapy after immediate breast reconstruction? vol.57, pp.5, 2012, https://doi.org/10.1111/1754-9485.12078
  3. Local recurrence of breast cancer in reconstructed breasts using TRAM flap after skin-sparing mastectomy: clinical and imaging features vol.24, pp.9, 2012, https://doi.org/10.1007/s00330-014-3214-x
  4. The Prognosis of Breast Cancer Patients after Mastectomy and Immediate Breast Reconstruction: A Meta-Analysis vol.10, pp.5, 2012, https://doi.org/10.1371/journal.pone.0125655
  5. Local recurrence following mastectomy and autologous breast reconstruction: incidence, risk factors, and management vol.9, pp.None, 2012, https://doi.org/10.2147/ott.s109356
  6. Oncologic Safety of Immediate Breast Reconstruction for Invasive Breast Cancer Patients: A Matched Case Control Study vol.19, pp.1, 2012, https://doi.org/10.4048/jbc.2016.19.1.68
  7. Prepectoral Breast Reconstruction: The Breast Surgeon’s Perspective vol.140, pp.6, 2012, https://doi.org/10.1097/prs.0000000000004050
  8. Reconstruction of extensive thoracic wall defect using the external oblique myocutaneous flap: An analysis on 20 Chinese patients with locally advanced soft tissue sarcoma vol.117, pp.2, 2012, https://doi.org/10.1002/jso.24823
  9. Current Trends in Prepectoral Breast Reconstruction: A Survey of American Society of Plastic Surgeons Members vol.8, pp.8, 2012, https://doi.org/10.1097/gox.0000000000003060
  10. Oncologic Safety of Immediate Breast Reconstruction : A Single-Center Retrospective Review of 138 Patients vol.87, pp.6, 2012, https://doi.org/10.1097/sap.0000000000002869
  11. Radiology in oncoplastic surgery vol.34, pp.suppl1, 2012, https://doi.org/10.1016/j.senol.2021.07.005