A Prospective Study on Skin-Sparing Mastectomy for Immediate Breast Reconstruction with Latissimus Dorsi Flap After Neoadjuvant Chemotherapy and Radiotherapy in Invasive Breast Carcinoma

Background Skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) is increasingly used in invasive breast cancer. However, adjuvant chemotherapy (CT) and radiotherapy (RT) can increase the rate of local complications. Objective The aim of this study was to assess the morbidity of S...

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Bibliographic Details
Published in:	Annals of surgical oncology Vol. 23; no. 7; pp. 2350 - 2356
Main Authors:	Zinzindohoué, Cécile, Bertrand, Pierre, Michel, Aude, Monrigal, Emilie, Miramand, Bernard, Sterckers, Nicolas, Faure, Christelle, Charitansky, Hélène, Gutowski, Marian, Cohen, Monique, Houvenaeghel, Gilles, Trentini, Frederic, Raro, Pedro, Daures, Jean-Pierre, Lacombe, Sandy
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01-07-2016 Springer Nature B.V Springer Verlag
Subjects:	Adolescent Adult Aged Breast Neoplasms - pathology Breast Neoplasms - surgery Breast Neoplasms - therapy Cancer Carcinoma, Ductal, Breast - pathology Carcinoma, Ductal, Breast - surgery Carcinoma, Ductal, Breast - therapy Carcinoma, Lobular - pathology Carcinoma, Lobular - surgery Carcinoma, Lobular - therapy Chemotherapy, Adjuvant Combined Modality Therapy Female Follow-Up Studies Human health and pathology Humanities and Social Sciences Humans Life Sciences Mammaplasty Mastectomy Medicine Medicine & Public Health Middle Aged Neoadjuvant Therapy Neoplasm Invasiveness Oncology Organ Sparing Treatments Pilot Projects Prognosis Prospective Studies Psychology Radiotherapy, Adjuvant Reconstructive Oncology Superficial Back Muscles - surgery Surgery Surgical Flaps Surgical Oncology Young Adult Latissimus Dorsi Flap Immediate Breast Reconstruction Necrosis Rate Transverse Rectus Abdominis Myocutaneous Skin Necrosis
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Summary:	Background Skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) is increasingly used in invasive breast cancer. However, adjuvant chemotherapy (CT) and radiotherapy (RT) can increase the rate of local complications. Objective The aim of this study was to assess the morbidity of SSM–IBR after neoadjuvant CT and RT. Methods A French prospective pilot study of women aged 18–75 years with invasive breast cancer requiring mastectomy after CT and RT. Reconstruction was performed using autologous latissimus dorsi flap with or without prosthesis. The primary endpoint was the skin necrosis rate within 6 months, while secondary endpoints included pathological complete response rate (pCR) and global morbidity. Results Among 94 patients included in this study, 83 were analyzed (mean age 45.2 ± 9.5 years, T1 23.6 %, T2 55.6 %, T3 18.1 %). All but one patient received anthracyclines and taxanes, and all patients received RT (49.3 ± 5.2 Gy) before SSM–IBR. Prostheses were used for IBR in 32 patients (mean volume 256 ± 73 mm 3 ). Five patients had necrosis (≤2 cm 2 , 2–10 cm 2 and >10 cm 2 , in three, one, and one cases, respectively), and they all recovered without revision surgery. Among 50 patients who underwent upfront mastectomy, 36 % achieved pCR. Conclusions SSM–IBR performed after CT and RT is safe, with an acceptable local morbidity rate. Long-term data are needed to evaluate recurrence rates.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1068-9265 1534-4681
DOI:	10.1245/s10434-016-5146-y