Patterns of local breast cancer recurrence after skin-sparing mastectomy and immediate breast reconstruction

Vaughan, Aislinn; Dietz, Jill R.; Aft, Rebecca; Gillanders, William E.; Eberlein, Timothy J.; Freer, Phoebe; Margenthaler, Julie A.

doi:10.1016/j.amjsurg.2007.06.011

« Previous Next »The American Journal of Surgery
Volume 194, Issue 4 , Pages 438-443, October 2007

Patterns of local breast cancer recurrence after skin-sparing mastectomy and immediate breast reconstruction

Presented at the 8th Annual Meeting of the American Society of Breast Surgeons, Phoenix, AZ, May 2–6, 2007

Aislinn Vaughan, M.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA
- Corresponding author. Tel.: +1-314-454-8820; fax: +1-314-454-5509.
Jill R. Dietz, M.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA
Rebecca Aft, M.D., Ph.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA
- Department of Surgery, John Cochran Veterans Hospital, 915 N. Grand Blvd, St. Louis, MO 63106, USA
William E. Gillanders, M.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA
Timothy J. Eberlein, M.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA
Phoebe Freer, M.D.
- Department of Radiology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8131, St. Louis, MO 63110, USA
Julie A. Margenthaler, M.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA

Received 30 April 2007; received in revised form 27 June 2007

Abstract

Background

Local recurrence rates after skin-sparing mastectomy and immediate reconstruction are similar to recurrence rates after conventional mastectomy. We investigated the pattern of local recurrences and risk factors associated with them.

Methods

We identified 206 patients who underwent 210 skin-sparing mastectomies with immediate reconstruction from 1998 to 2006 in our database.

Results

Eleven patients had local recurrences (5.3%). Nine developed in the quadrant of the corresponding primary tumor. There were no significant differences between patients who recurred and those who did not with respect to tumor size/stage, margin status, estrogen receptor/progesterone receptor/Her2neu status, lymph node metastases, or radiation therapy (P > .05). Patients with grade 3 invasive tumors or high-grade ductal carcinoma in situ were more likely to recur than patients with grade 1 or 2 invasive tumors or low- or intermediate-grade ductal carcinoma in situ (P = .0035). Those patients who recurred had a significantly decreased overall survival compared to patients who did not recur (P = .0006).

Conclusions

Skin-sparing mastectomy and immediate reconstruction has a low local recurrence rate. Recurrences occur most commonly in the same quadrant as the primary tumor and treatment approaches include surgery, chemotherapy, and radiation therapy. Local recurrence portends a poorer overall survival.

Keywords: Breast cancer, Skin-sparing mastectomy, Local recurrence, Immediate breast reconstruction