Application of Screening Principles to the Reconstructed Breast

Abstract

A significant number of women choose mastectomy for the treatment of early and locally advanced breast cancer. Advances in reconstruction techniques and greater awareness of options have led to an increased use of immediate breast reconstruction, which has resulted in uncertainty for the management of surveillance for local recurrence. In this article, we review mastectomy and reconstruction trends and how these techniques affect the frequency and location of local recurrence. The data on surveillance imaging of the reconstructed breast are extremely limited. However, by assessing the potential role for imaging in this setting and applying the principles of screening, we have identified that there is a potential theoretic advantage of surveillance imaging in a very small subset of women: those with autologous tissue reconstructions and moderate to high risk of recurrence. A prospective registry study of surveillance imaging in this target population would be the appropriate way to determine its benefit and its impact on survival outcomes. In this review article, we will detail the reasons that should allow clinicians to forego routine surveillance imaging in the majority of women who undergo mastectomy and reconstruction.

Surveillance mammography for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer: a systematic review

“…Furthermore, the study conducted by Boné and colleagues [7] included only mastectomy patients who underwent breast reconstruction using implants. Surveillance of the chest wall and/or the reconstructed breast in patients receiving either mastectomy alone, or mastectomy with breast reconstruction and implants, varies according to different health care systems and local protocols [16–18]. These comprise an increasingly relevant sub-group of women, because of increasing rates of breast reconstruction procedures, who might receive routine surveillance mammography in the future [19].…”

Effect of Implant vs. Tissue Reconstruction on Cancer Specific Survival Varies by Axillary Lymph Node Status in Breast Cancer Patients

“…Additionally, there are no guidelines or consensus for optimal screening program in patients after breast reconstruction. The implant is placed behind the pectoralis major muscle, which displaces the entire mastectomy site anteriorly; therefore, physical examination of the skin and chest wall is very effective for surveillance[ 16 ]. In contrast, tissue-reconstruction patients may need post-operative mammography screening because nearly a third of the recurrences cannot be detected by physical examinations alone in this setting[ 16 ].…”

Does Immediate Breast Reconstruction after Mastectomy affect the Initiation of Adjuvant Chemotherapy?

“…Since IBR enhances psychological recovery from breast cancer [1-3] and seems to be oncologically safe [11,12], IBR procedures have been widely implemented in oncoplastic surgical practice [13-16]. IBR is now established as a valuable option for patients undergoing mastectomy.…”