Pattern of local recurrence after mastectomy and reconstruction in breast cancer patients: a systematic review

Abstract

Background: This study aimed to describe the locations of local recurrences based on the mastectomy and reconstruction type in breast cancer patients.Methods: In November 2020, a systematic literature review was performed through MEDLINE/PubMed and the Cochrane Centre Register of Controlled Trials. Publications that included skin-sparing or nipplesparing mastectomy followed by breast reconstruction and described the location of local recurrences were analyzed. Exclusion criteria included salvage or prophylactic mastectomy, unclear distinction between local and regional recurrences, rare tumor types.Results: From 19 publications, 272 local recurrences lesions were reported in a total of 4,787 patients.After autologous reconstruction (n=2,465), local recurrences were located in the skin in 45 (1.8%) patients, in the chest wall in 18 (0.7%), and in the nipple-areolar complex in 9 (0.4%). After implant reconstruction (n=1,917), local recurrences sites included the skin in 91 (4.7%) patients, chest wall in 8 (0.4%), and nippleareolar complex in 8 (0.4%). Of the 70 lesions with reported in-breast location, 57 (81.4%) relapsed in the original tumor location.Discussion: Although meta-analysis was not conducted, present analysis demonstrated that most local recurrences after skin-sparing or nipple-sparing mastectomy occurred within the skin or subcutaneous tissues. It was found that the original tumor location was the most frequent site of relapse. Therefore, special attention should be paid to the original tumor overlying the skin while planning postmastectomy radiation therapy.

Breast cancer local recurrence after mastectomy with immediate latissimus dorsi myocutaneous flap reconstruction: A case report

“…Most local recurrences of breast cancer in reconstructed breasts occur at the level of the skin. 4,5 In the present case, local recurrence occurred in the deep tissue of the reconstructed breast, in addition to the superficial tissue of the reconstructed breast. There are few reports of multiple local recurrences in reconstructed breast tissue.…”

Suggestion for the omission of post-mastectomy chest wall radiation therapy in patients who underwent skin-sparing/nipple-sparing mastectomy

“…However, PMRT involving chest wall RT can lead to poor cosmetic outcomes and increased toxicities [10]. Therefore, identifying the risk factors of IBTR [11]. In the current study, we identified a favorable 5-year IBTR-free rate of 97.2% in 556 patients after SSM or NSM in pT1-2N0-1 disease.…”

“…Therefore, identifying the risk factors of IBTR could stratify patients for whom chest wall RT can be omitted. Although previous studies have shown a low IBTR rate of 5%, little data regarding the risk factors of IBTR following SSM/NSM exists [ 11 ]. In the current study, we identified a favorable 5-year IBTR-free rate of 97.2% in 556 patients after SSM or NSM in pT1-2N0-1 disease.…”

“…A recent meta-analysis including 3365 patients from 19 studies demonstrated 3.5% and 5.2% IBTR after SSM and NSM for mostly early-stage breast cancer, respectively ( Table 4 ) [ 11 ]. Despite wide range of adopting PMRT, overall IBTR events after SSM/NSM were infrequent (about 5%, Table 4 ).…”

“…Based on the low rate of local recurrence (<5%) following SSM or NSM in pT1-2 disease, de-escalating PMRT by omitting chest wall irradiation could minimize possible toxicities [ 11 ]. However, few data are available to show the possible risk factors for recurrences limited to the ipsilateral chest wall/skin following SSM or NSM [ [12] , [13] , [14] , [15] ].…”