Reconstruction of the Anterior Chest Wall After Subtotal Sternectomy for Metastatic Breast Cancer: Report of a Case

Abstract

We describe our successful operative management of a solitary metastasis in the sternal body after modified left mastectomy. Because the primary lesion was well controlled and the sternal metastasis was isolated, we performed a subtotal sternectomy, with full-thickness resection of the anterior chest wall, including the sternal body and inferior part of the manubrium (14.5 cm x 8.5 cm x 3.0 cm). A prosthesis was created to fill the defect, by sandwiching molded bone cement (methylmethacrylate) between two layers of Prolene mesh. The prosthesis was fixed to the cut ends of the costal cartilages and the residual manubrium. The patient had an uneventful course, and her respirations were normal without paradoxical movement of the thorax or hypoxemia. The skin covering the prosthesis healed well. Thus, the creation of an artificial chest wall from methylmethacrylate and Prolene mesh is a useful technique for repairing sternal defects.

Sternal Resection and Reconstruction for Local Recurrence of Breast Cancer Using the Sternal Allograft Transplantation Technique

“…In all cases the treatment of the recurrence should be based on a multimodality approach [3,4]. Sternectomy could be indicated with a palliative intent or in a curative setting [3][4][5]. [4] reported no hospital or 30-day mortality in a population of 18 patients who underwent sub-total or total sternectomy for recurrent breast cancer.…”

“…The reported post-operative morbidity is not negligible, ranging from 7.9% to 26.7% [5][6][7]. In particular, the respiratory disturbance due to incorrect reconstruction of the anterior chest wall is the major problem [5]. Different techniques for chest wall reconstruction have been described using synthetic or biological materials [6][7][8].…”

“…Neoplastic involvement of the sternum is definitely a challenging situation for the surgeon, who needs to perform a radical operation with wide resection margins and at the same time to reconstruct the anatomy of the thorax in order ensure a good respiratory function [6,7]. The reported post-operative morbidity is not negligible, ranging from 7.9% to 26.7% [5][6][7]. In particular, the respiratory disturbance due to incorrect reconstruction of the anterior chest wall is the major problem [5].…”

“…Nowadays, the treatment of haematogenous solitary sternal metastases or direct local sternal/parasternal invasion by the breast cancer is still controversial [3,4]. Partial or complete sternectomy associated or not with the resection of other related surrounding tissues is the technique of choice to obtain safety margins and the radical treatment of the disease [3][4][5][6]. The most challenging part is the reconstruction of the anterior chest wall in order to prevent respiratory insufficiency, local infection, injuries to mediastinal structures, functional and cosmetic results.…”

Titanium plates support for chest wall reconstruction with Gore-Tex® dual mesh after sternochondral resection

“…Prosthetic materials are usually used for this purpose [2][3][4]. However, they are either excessively rigid (methyl methacrylate), with subsequent limitation of chest wall movements and danger of erosion of adjacent structures, or too weak (prolene mesh), to provide sufficient support for vital organs.…”