DIEAP Flap Breast Reconstruction Followed by Local Recurrence of Breast Cancer

Abstract

Local recurrence after an autologous breast reconstruction is uncommon. We describe 2 patients with local recurrence 3 and 9 years, respectively, after mastectomy with DIEAP (deep inferior epigastric artery perforator) flap breast reconstruction. Patients generally present with a palpable mass, pain, or other visible abnormalities. Various imaging techniques are helpful, always completed by biopsy to characterize the tumour. A repeated sentinel node procedure can be useful in staging. The treatment of the local recurrence needs to be determined in a multidisciplinary team consultation.

Importance of long-term monitoring of patients with breast reconstructions: a case of 10-year cancer recurrence

“…This patient’s recurrence, occurring 10 years after primary oncological surgery, demonstrates the ongoing risk, and the role that plastic surgeons, who may see patients later in their recovery for delayed reconstruction, can fill in emphasising this ongoing risk. Whilst evidence to date argues against routine imaging screening in cancer patients who undergo ipsilateral breast reconstruction, late recurrence is still well-documented; Case reports of late recurrence post reconstruction have been published following DIEP flaps at 3 and 9 years post mastectomy in patients treated for intraductal carcinoma [ 15 ].…”

“…Based on cancer biology, we may assume that this patient’s recurrence was already present in a subclinical context, and that the imaging and additional examinations that followed late reconstruction and fat grafting simply expedited clinical detection. Cases such as ours [ 15 ] where interval follow up for delayed reconstruction facilitated detection of cancer recurrence, suggest an extension of the time window for repeat clinical examination in high risk patients may be warranted. Indeed this would likely be in accord with patients’ wishes; In a survey of breast cancer survivors, 56/84 indicated they would like to attend lifelong follow up [ 27 ].…”

“…On imaging, it can appear as a smooth bordered lucent mass resembling a cyst or, less commonly, as pleomorphic calcifications, which render its differentiation from recurrent tumour more difficult [ 14 ]. A biopsy is mandatory to investigatesuspicious findings on imaging or physical examination [ 15 ].…”