Contemporary Trends in Reconstruction for Patients With Sarcoma of the Breast

Introduction: Breast sarcomas are rare, heterogeneous malignancies often associated with prior radiation and require a multidisciplinary approach, including a comprehensive reconstruction plan. We analyzed reconstructive outcomes in a large cohort of patients with breast sarcomas and provide a contemporary treatment algorithm. Methods: We retrospectively reviewed patients who underwent breast reconstruction after surgical treatment for breast sarcoma at our institution between January 2010 and December 2023. We analyzed patient and tumor characteristics, oncologic treatments, reconstructive approaches, and outcomes. Results: Eighty patients underwent 81 reconstructions. The median age at diagnosis was 53 years. The most common subtypes were primary angiosarcoma (35.8%) and radiation-associated angiosarcoma (33.3%). The median follow-up was 23 months. Oncologic management was multimodal: 63.0% received preoperative chemotherapy, 59.3% received post-operative chemotherapy, 35.8% received both pre- and post-operative chemotherapy, and 34.6% received pre- or post-operative radiation therapy. Forty-three (53.1%) patients underwent total mastectomy with or without chest wall resection requiring soft-tissue reconstruction. Thirty-eight (46.9%) patients underwent formal breast reconstruction. Autologous reconstructions included local tissue rearrangement (39.5%), pedicled flaps (18.5%), regional flaps (16.0%), and free flaps (13.6%). Most patients (82.7%) underwent immediate reconstruction. Conclusion: Breast sarcomas are managed with multimodal therapy, and most patients undergo immediate reconstruction. Autologous reconstruction remains the first choice in radiated patients, however implant-based reconstruction has increased with modern approaches. Complication rates are acceptable and similar across sarcoma subtypes. Breast reconstruction is an essential component of care for these patients and can be performed safely and with good results.