TY - JOUR
T1 - Treatment and outcome of patients with chest wall recurrence after mastectomy and breast reconstruction
AU - Chagpar, Anees
AU - Langstein, Howard N.
AU - Kronowitz, Steven J.
AU - Singletary, S. Eva
AU - Ross, Merrick I.
AU - Buchholz, Thomas A.
AU - Hunt, Kelly K.
AU - Kuerer, Henry M.
N1 - Funding Information:
Supported in part by the Susan G. Komen Breast Cancer Foundation.
PY - 2004/2
Y1 - 2004/2
N2 - Background: Chest wall recurrence (CWR) in the setting of previous mastectomy and breast reconstruction can pose complex management dilemmas for clinicians. We examined the impact of breast reconstruction on the treatment and outcomes of patients who subsequently developed a CWR. Methods: Between 1988 and 1998, 155 breast cancer patients with CWR after mastectomy were evaluated at our center. Of these patients, 27 had previously undergone breast reconstruction (immediate in 20; delayed in 7). Clinicopathologic features, treatment decisions, and outcomes were compared between the patients with and without previous breast reconstruction. Nonparametric statistics were used to analyse the data. Results: There were no significant differences between the reconstruction and no-reconstruction groups in time to CWR, size of the CWR, number of nodules, ulceration, erythema, and association of CWR with nodal metastases. In patients with previous breast reconstruction, surgical resection of the CWR and repair of the resulting defect tended to be more complex and was more likely to require chest wall reconstruction by the plastic surgery team rather than simple excision or resection with primary closure (26% [7 of 27] versus 8% [10 of 128], P = 0.013). Risk of a second CWR, risk of distant metastases, median overall survival after CWR, and distant-metastasis-free survival after CWR did not differ significantly between patients with and without previous breast reconstruction. Conclusions: Breast reconstruction after mastectomy does not influence the clinical presentation or prognosis of women who subsequently develop a CWR. Collaboration with a plastic surgery team may be beneficial in the surgical management of these patients.
AB - Background: Chest wall recurrence (CWR) in the setting of previous mastectomy and breast reconstruction can pose complex management dilemmas for clinicians. We examined the impact of breast reconstruction on the treatment and outcomes of patients who subsequently developed a CWR. Methods: Between 1988 and 1998, 155 breast cancer patients with CWR after mastectomy were evaluated at our center. Of these patients, 27 had previously undergone breast reconstruction (immediate in 20; delayed in 7). Clinicopathologic features, treatment decisions, and outcomes were compared between the patients with and without previous breast reconstruction. Nonparametric statistics were used to analyse the data. Results: There were no significant differences between the reconstruction and no-reconstruction groups in time to CWR, size of the CWR, number of nodules, ulceration, erythema, and association of CWR with nodal metastases. In patients with previous breast reconstruction, surgical resection of the CWR and repair of the resulting defect tended to be more complex and was more likely to require chest wall reconstruction by the plastic surgery team rather than simple excision or resection with primary closure (26% [7 of 27] versus 8% [10 of 128], P = 0.013). Risk of a second CWR, risk of distant metastases, median overall survival after CWR, and distant-metastasis-free survival after CWR did not differ significantly between patients with and without previous breast reconstruction. Conclusions: Breast reconstruction after mastectomy does not influence the clinical presentation or prognosis of women who subsequently develop a CWR. Collaboration with a plastic surgery team may be beneficial in the surgical management of these patients.
KW - Breast cancer
KW - Chest wall recurrence
KW - Prognosis
KW - Reconstruction
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U2 - 10.1016/j.amjsurg.2003.11.006
DO - 10.1016/j.amjsurg.2003.11.006
M3 - Article
C2 - 14769300
AN - SCOPUS:0842330932
SN - 0002-9610
VL - 187
SP - 164
EP - 169
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 2
ER -