Safety of Partial Breast Reconstruction in Extended Indications for Conservative Surgery in Breast Cancer

Abstract

Breast conservation surgery after large volume excisions for women with relatively larger or multicentric operable breast cancer (OBC) and in some locally advanced breast cancers (LABC) post neo-adjuvant chemotherapy (NACT), is known to be a feasible option using a latissimus dorsi flap. However, the oncological safety of such a procedure is not well reported in literature. Two hundred and twenty one women with breast cancer (148-OBC, 73-LABC) underwent BCT plus LD during March 1998 to August 2009. One hundred and forty six women (72-LABC, 66-OBC) received prior NACT for downstaging, followed by completion of adjuvant therapy in all, including postoperative radiotherapy and hormone therapy where indicated. Women aged 20-62 years, with tumors 1.5-15 cm (median 5.0 cm), underwent volume replacement surgery with LD flap. All positive cut margins (total-4.9%, gross positive-1.3%) were re-excised to ensure negative margins. The mean surgical time for excision of primary with axillary clearance followed by volume replacement by LD was 5 h and mean hospital stay 6 days. Donor site morbidity was seen in 11 patients and 3 had minor recipient site infection. At a median follow up of 36 months, ten of 221 patients (4.5%) had failed locally (7-OBC, 3-LABC). The determinants of local recurrence were presence of lymphatic vascular invasion (p = 0.016) and axillary metastasis (p = 0.003). BCT plus LD flap is an oncologically safe, technically quick procedure with minimal morbidity, and should be offered to all eligible women as an extended breast conservation procedure.

The Integrated Evaluation of the Results of Oncoplastic Surgery for Locally Advanced Breast Cancer

“…The complication rate and delay in systemic therapy seem to be not the question of debate. Although the postoperative complications rate ranges from 16% to 24% , in recent studies it lowers to 6% with no delay in further treatment . The morbidity rate of 5% in our study seems to be too low in comparison with other trials, but we did not consider seroma after harvesting LD flap as a complication.…”

“…The satisfaction survey indicated a very high level of satisfaction among women who underwent breast conservation and oncoplastic surgery . There have been studies evaluating the QoL and self‐assessment and have reported that women have better self‐opinion with a better breast cosmesis (p = 0.004), feel that the reconstructed breast is more like the opposite breast, that women have less loss of self‐confidence, and would choose this operation over total breast reconstruction (p = 0.002).…”

Feasibility, safety, and clinical outcomes following latissimus dorsi flap reconstruction in breast cancer- an Institutional study

“…In our country where the incidence of LABC is comparatively higher than in the western world, using an LD flap helps to extend the indications for breast conservation. Parmar et al, from the Tata Memorial Hospital, have shown that using an LD flap in post NACT patients who have had breast reconstruction is feasible and produces satisfactory outcomes. Thirty‐one patients in our study underwent reconstruction with an LD flap after NACT and had good outcomes.…”

“…This flap does not pose any problems during follow‐up; it is a radiolucent flap; follow‐up can be done by mammography and clinical examination …”

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

“…The possibility of breast conservation in cases of LABC has been demonstrated in single-institution experiences with small numbers and long follow-up. There are also single institutional experiences with large number of LABC patients, but with short follow-up results [2][3][4]. The only prospective randomized trial, LAMANOMA, failed due to insufficient accrual of the patients [5].…”