Immediate breast reconstruction with latissimus dorsi flap for patients with local recurrence of breast cancer

Lorenzi, Francesca De; Corso, Giovanni; Botta, Francesca; Invento, Alessandra; Marchetti, Alberto; Sala, P.; Vottero, G; Bagnardi, Vincenzo; Leonardi, C.; Veronesi, Giulia; Goldhirsch, Aron

doi:10.1016/j.ejso.2020.01.015

Cited by 7 publications

(7 citation statements)

References 24 publications

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“…Volume replacement technique for central tumours described in the literature involves partial breast reconstruction using a latissimus dorsi flap [26,[46][47][48][49][50][51], which adds significant muscle morbidity. Other techniques of volume replacement like use of omental flap [52] or free dermal fat graft [43] have not been easy to reproduce and can have a significant risk of complications.…”

Section: Discussionmentioning

confidence: 99%

Extreme oncoplasty for centrally located breast cancer in small non-ptotic breasts: extending the indications of chest wall perforator flaps with areolar reconstruction

Nigam¹,

Eichholz²,

Bhattacharyya³

et al. 2021

ecancer

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Background Breast cancers located centrally require excision of nipple-areola complex. A simple central wide excision is a safe option but results in suboptimal aesthetic outcome. An oncoplastic option involves therapeutic mammoplasty with or without areolar reconstruction, limited to moderate and large ptotic breasts. For small non-ptotic breasts, most surgeons would resort to mastectomy with/without reconstruction. Methods Lateral chest wall perforator flap (CWPF) is an option for partial breast reconstruction in small to moderate sized, non-ptotic breasts for laterally located tumours. We have extended the application of CWPF for central tumours to avoid mastectomy in selected patients. Results We here present a case series of four patients with small to medium-sized non-ptotic breasts, who had centrally located breast cancer or ductal carcinoma in-situ (DCIS). Three patients had single stage CWPF reconstruction, and one had central excision with immediate reconstruction following a failed attempt at therapeutic mammoplasty. All had the areola reconstructed using flap skin; one patient had simultaneous nipple reconstruction. Conclusions CWPF is an option for treatment of centrally located breast cancers/DCIS needing nipple-areola complex excision for patients wishing to avoid mastectomy. Patients with small to medium-sized non-ptotic breasts are suitable, and need to be carefully selected.

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Section: Discussionmentioning

confidence: 99%

Extreme oncoplasty for centrally located breast cancer in small non-ptotic breasts: extending the indications of chest wall perforator flaps with areolar reconstruction

Nigam¹,

Eichholz²,

Bhattacharyya³

et al. 2021

ecancer

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“…The surgical complication rate after primary mastectomy (varying from seroma, wound infection and wound dehiscence) varies between 10 and 30% in recent studies [20,21]. The incidence of seroma and other short-term complications in patients with salvage mastectomy after previous irradiation as part of a primary breast-conserving treatment varies from 17 to 27% [22][23][24]. One would expect that repeat breast-conserving surgery in a previously irradiated area could yield wound healing problems, leading to delay of the re-irradiation, a worse cosmetic outcome or ultimately the need for a salvage mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Repeat breast-conserving treatment of ipsilateral breast cancer recurrence: a nationwide survey amongst breast surgeons and radiation oncologists in the Netherlands

Walstra

Schipper

Riet

et al. 2021

Breast Cancer Res Treat

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Background In line with the paradigm to minimize surgical morbidity in patients with primary breast cancer, there is increasing evidence for the safety of a repeat breast-conserving treatment (BCT) of an ipsilateral breast tumour recurrence (IBTR) in selected patients. The conditions for the feasibility of a repeat BCT vary widely in literature. In clinical practice, many physicians have ongoing concerns about the oncological safety and possible toxicity of repeat BCT. Aim To investigate the attitude of Dutch breast surgeons and radiation oncologists towards repeat BCT and to report on their experiences with, objections against and perceived requirements to consider a repeat BCT in case of IBTR. Patients and methods An online survey consisting of a maximum of 26 open and multiple-choice questions about repeat BCT for IBTR was distributed amongst Dutch breast surgeons and radiation oncologists. Results Forty-nine surgeons representing 49% of Dutch hospitals and 20 radiation oncologists representing 70% of Dutch radiation oncology centres responded. A repeat BCT was considered feasible in selected cases by 28.7% of breast surgeons and 55% of radiation oncologists. The most important factors to consider a repeat BCT for both groups were the patient’s preference to preserve the breast and surgical feasibility of a second lumpectomy. Arguments against a repeat BCT were based on the perceived unacceptable toxicity and cosmesis of a second course of radiotherapy. The technique of preference for re-irradiation would be partial breast irradiation (PBI) according to all radiation oncologists. Differentiating between new primary tumours (NPT) and true recurrences (TR) was reported to be done by 57.1% of breast surgeons and 60% of radiation oncologists. The most important reason to differentiate between NPT and TR was to establish prognosis and to consider whether a repeat BCT would be feasible. Conclusion An increasing number of Dutch breast cancer specialists is considering a repeat BCT feasible in selected cases, at the patient’s preference and with partial breast re-irradiation.

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“…The surgical complication rate after primary mastectomy (varying from seroma, wound infection and wound dehiscence) varies between 10-30% in recent studies 20,21 . The incidence of seroma and other short-term complications in patients with salvage mastectomy after previous irradiation as part of a primary breast-conserving treatment varies from 17% to 27% [22][23][24] . One would expect that repeat breast-conserving surgery in a previously irradiated area could yield wound-healing problems, leading to delay of the re-irradiation, a worse cosmetic outcome or ultimately the need for a salvage mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Repeat breast-conserving treatment of ipsilateral breast cancer recurrence: a nationwide survey amongst breast surgeons and radiation oncologists in the Netherlands

Walstra

Schipper

Riet

et al. 2021

Preprint

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BACKGROUND In line with the paradigm to minimize surgical morbidity in patients with primary breast cancer, there is increasing evidence for the safety of a repeat breast-conserving treatment (BCT) of an ipsilateral breast tumor recurrence (IBTR) in selected patients. The conditions for the feasibility of a repeat BCT vary widely in literature. In clinical practice, many physicians have ongoing concerns about the oncological safety and possible toxicity of repeat BCT.AIM To investigate the attitude of Dutch breast surgeons and radiation oncologists towards repeat BCT and to report on their experiences with, objections against, and perceived requirements to consider a repeat BCT in case of IBTR.PATIENTS AND METHODS An online survey consisting of a maximum of 26 open and multiple choice questions about repeat BCT for IBTR was distributed amongst Dutch breast surgeons and radiation oncologists.RESULTS Forty-nine surgeons representing 49% of Dutch hospitals and 20 radiation oncologists representing 70% of Dutch radiation oncology centers responded. A repeat BCT was considered feasible in selected cases by 28.7% of breast surgeons and 55% of radiation oncologists. The most important factors to consider a repeat BCT for both groups were the patient’s preference to preserve the breast and surgical feasibility of a second lumpectomy. Arguments against a repeat BCT were based on the perceived unacceptable toxicity and cosmesis of a second course of radiotherapy. The technique of preference for re-irradiation would be partial breast irradiation (PBI) according to all radiation oncologists. Differentiating between new primary tumours (NPT) and true recurrences (TR) was reported to be done by 57.1% of breast surgeons and 60% of radiation oncologists. The most important reason to differentiate between NPT and TR was to establish prognosis and to consider whether a repeat BCT would be feasible.CONCLUSION An increasing number of Dutch breast cancer specialists is considering a repeat BCT feasible in selected cases, at the patient’s preference and with partial breast re-irradiation.

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Immediate breast reconstruction with latissimus dorsi flap for patients with local recurrence of breast cancer

Cited by 7 publications

References 24 publications

Extreme oncoplasty for centrally located breast cancer in small non-ptotic breasts: extending the indications of chest wall perforator flaps with areolar reconstruction

Extreme oncoplasty for centrally located breast cancer in small non-ptotic breasts: extending the indications of chest wall perforator flaps with areolar reconstruction

Repeat breast-conserving treatment of ipsilateral breast cancer recurrence: a nationwide survey amongst breast surgeons and radiation oncologists in the Netherlands

Repeat breast-conserving treatment of ipsilateral breast cancer recurrence: a nationwide survey amongst breast surgeons and radiation oncologists in the Netherlands

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