Loco-regional recurrence after skin and nipple-sparing mastectomy and immediate breast reconstruction using free flap autologous tissue in a single institution

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2021-08, Vol.74 (8), p.1770-1778
• Main Authors: Stansfield, J, Koshy, O, Shah, A, Thompson, P, Riogi, B, Taghizadeh, R, Bennett, S, Chagla, L
• Format: Article
• Language: English
• Subjects: Breast cancer; Immediate breast reconstruction; Loco-regional recurrence; Nipple-sparing mastectomy; Skin-sparing mastectomy
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2020.12.008

Immediate autologous tissue breast reconstruction after skin- and nipple-sparing mastectomy, is becoming increasingly popular, while the benefits are evident, the concern is in leaving breast tissue under the skin envelope, which could potentially lead to a higher chance of recurrence. We aim to determine the incidence and study the management of loco-regional recurrence (LR) of breast cancer following immediate autologous free flap reconstruction (AFFR) from a 10-year database at a single tertiary breast unit. This is a retrospective analysis of a prospectively maintained database of consecutive patients who underwent AFFR between July 2008 and December 2018. All patients undergoing delayed reconstruction and risk-reducing surgery were excluded, leaving a total of 216 patients. Statistical analysis was performed to determine significance in the prediction of LR. Management and outcome of the LR was also studied. LR was found in 7/216 cases (3.25%). The median age at surgery for patients with LR, was 45 (range 31–54). Median time to recurrence was 54 months (7–79 months). Three patients presented with self-detected lesions. In all, 6/7 patients were ER/PR positive, 2/7 were HER2 + at recurrence, and 1/7 was triple negative. All patients underwent surgical excision for the LR followed by radiotherapy, either chemotherapy (n-5) and/or hormone therapy (n-2). No patients have developed further LR. Because of low numbers of recurrences, no statistical significance was observed for factors causing recurrence. The low LR we report demonstrates that immediate AFFR is oncologically safe. Timely recognition through post-reconstruction patient education and appropriate management results in good outcomes.