Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2016

01-07-2016 | Reconstructive Oncology

A Prospective Study on Skin-Sparing Mastectomy for Immediate Breast Reconstruction with Latissimus Dorsi Flap After Neoadjuvant Chemotherapy and Radiotherapy in Invasive Breast Carcinoma

Authors: Cécile Zinzindohoué, MD, Pierre Bertrand, MD, Aude Michel, PhD, Emilie Monrigal, MD, Bernard Miramand, MD, Nicolas Sterckers, MD, Christelle Faure, MD, Hélène Charitansky, MD, Marian Gutowski, MD, Monique Cohen, MD, Gilles Houvenaeghel, MD, PhD, Frederic Trentini, MD, Pedro Raro, MD, Jean-Pierre Daures, MD, PhD, Sandy Lacombe, MA

Published in: Annals of Surgical Oncology | Issue 7/2016

Login to get access

Abstract

Background

Skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) is increasingly used in invasive breast cancer. However, adjuvant chemotherapy (CT) and radiotherapy (RT) can increase the rate of local complications.

Objective

The aim of this study was to assess the morbidity of SSM–IBR after neoadjuvant CT and RT.

Methods

A French prospective pilot study of women aged 18–75 years with invasive breast cancer requiring mastectomy after CT and RT. Reconstruction was performed using autologous latissimus dorsi flap with or without prosthesis. The primary endpoint was the skin necrosis rate within 6 months, while secondary endpoints included pathological complete response rate (pCR) and global morbidity.

Results

Among 94 patients included in this study, 83 were analyzed (mean age 45.2 ± 9.5 years, T1 23.6 %, T2 55.6 %, T3 18.1 %). All but one patient received anthracyclines and taxanes, and all patients received RT (49.3 ± 5.2 Gy) before SSM–IBR. Prostheses were used for IBR in 32 patients (mean volume 256 ± 73 mm3). Five patients had necrosis (≤2 cm2, 2–10 cm2 and >10 cm2, in three, one, and one cases, respectively), and they all recovered without revision surgery. Among 50 patients who underwent upfront mastectomy, 36 % achieved pCR.

Conclusions

SSM–IBR performed after CT and RT is safe, with an acceptable local morbidity rate. Long-term data are needed to evaluate recurrence rates.
Appendix
Available only for authorised users
Literature
1.
2.
Heneghan HM, Prichard RS, Lyons R, et al. Quality of life after immediate breast reconstruction and skin-sparing mastectomy: a comparison with patients undergoing breast conserving surgery. Eur J Surg Oncol. 2011;37:937–943.CrossRefPubMed
3.
Carlson GW, Page A, Johnson E, et al. Local recurrence of ductal carcinoma in situ after skin-sparing mastectomy. J Am Coll Surg. 2007;204:1074–1078; discussion 1078–1080CrossRefPubMed
4.
Carlson GW, Bostwick J 3rd, Styblo TM, et al. Skin-sparing mastectomy. Oncologic and reconstructive considerations. Ann Surg. 1997;225:570–575; discussion 575–578.PubMed
5.
Carlson GW, Losken A, Moore B, et al. Results of immediate breast reconstruction after skin-sparing mastectomy. Ann Plast Surg. 2001;46:222–228.CrossRefPubMed
6.
Downes KJ, Glatt BS, Kanchwala SK, et al. Skin-sparing mastectomy and immediate reconstruction is an acceptable treatment option for patients with high-risk breast carcinoma. Cancer. 2005;103:906–913.CrossRefPubMed
7.
Greenway RM, Schlossberg L, Dooley WC. Fifteen-year series of skin-sparing mastectomy for stage 0 to 2 breast cancer. Am J Surg. 2005;190:918–922.CrossRefPubMed
8.
Meretoja TJ, von Smitten KA, Leidenius MH, et al. Local recurrence of stage 1 and 2 breast cancer after skin-sparing mastectomy and immediate breast reconstruction in a 15-year series. Eur J Surg Oncol. 2007;33:1142–1145.CrossRefPubMed
9.
Patterson SG, Teller P, Iyengar R, et al. Locoregional recurrence after mastectomy with immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. Ann Surg Oncol. 2012;19:2679–2684.CrossRefPubMed
10.
Romics L Jr, Chew BK, Weiler-Mithoff E, et al. Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg. 2012;99:799–806.CrossRefPubMed
11.
Rancati A, Soderini A, Dorr J, et al. One-step breast reconstruction with polyurethane-covered implants after skin-sparing mastectomy. J Plast Reconstr Aesthet Surg. 2013;66:1671–1675.CrossRefPubMed
12.
Kronowitz SJ, Robb GL. Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg. 2004;114:950–960.CrossRefPubMed
13.
Motwani SB, Strom EA, Schechter NR, et al. The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys. 2006;66:76–82.CrossRefPubMed
14.
Nahabedian MY, Momen B. The impact of breast reconstruction on the oncologic efficacy of radiation therapy: a retrospective analysis. Ann Plast Surg. 2008;60:244–250.CrossRefPubMed
15.
Prabhu R, Godette K, Carlson G, et al. The impact of skin-sparing mastectomy with immediate reconstruction in patients with Stage III breast cancer treated with neoadjuvant chemotherapy and postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2012;82:e587–593.CrossRefPubMed
16.
Rey P, Martinelli G, Petit JY, et al. Immediate breast reconstruction and high-dose chemotherapy. Ann Plast Surg. 2005;55:250–254.CrossRefPubMed
17.
Gianni L, Baselga J, Eiermann W, et al. Phase III trial evaluating the addition of paclitaxel to doxorubicin followed by cyclophosphamide, methotrexate, and fluorouracil, as adjuvant or primary systemic therapy: European Cooperative Trial in Operable Breast Cancer. J Clin Oncol. 2009;27:2474–2481.CrossRefPubMed
18.
Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26:778–785.CrossRefPubMed
19.
Senkus E, Kyriakides S, Penault-Llorca F, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi7–23.CrossRefPubMed
20.
Monrigal E, Dauplat J, Gimbergues P, et al. Mastectomy with immediate breast reconstruction after neoadjuvant chemotherapy and radiation therapy. A new option for patients with operable invasive breast cancer. Results of a 20 years single institution study. Eur J Surg Oncol. 2011;37:864–870.CrossRefPubMed
21.
Chevallier B, Roche H, Olivier JP, et al. Inflammatory breast cancer. Pilot study of intensive induction chemotherapy (FEC-HD) results in a high histologic response rate. Am J Clin Oncol. 1993;16:223–228.CrossRefPubMed
22.
Peled AW, Foster RD, Stover AC, et al. Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol. 2012;19:3402–3409.CrossRef
23.
Petersen A, Eftekhari AL, Damsgaard TE. Immediate breast reconstruction: a retrospective study with emphasis on complications and risk factors. J Plast Surg Hand Surg 2012;46:344–348.CrossRefPubMed
24.
Kim Z, Kang SG, Roh JH, et al. Skin-sparing mastectomy and immediate latissimus dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes. World J Surg Oncol. 2012;10:259.CrossRefPubMedPubMedCentral
25.
Ho AL, Tyldesley S, Macadam SA, Lennox PA. Skin-sparing mastectomy and immediate autologous breast reconstruction in locally advanced breast cancer patients: a UBC perspective. Ann Surg Oncol. 2012;19:892–900.CrossRefPubMed
26.
Giacalone PL, Rathat G, Daures JP, et al. New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study. Breast Cancer Res Treat. 2010;122:439–451.CrossRefPubMed
27.
Delbaere M, Delaporte T, Toussoun G, Delay E. Skin-sparing mastectomies: how to avoid skin necrosis? [in French]. Ann Chir Plast Esthet. 2008;53:208–225.CrossRefPubMed
28.
Kroll SS, Schusterman MA, Reece GP, et al. Breast reconstruction with myocutaneous flaps in previously irradiated patients. Plast Reconstr Surg. 1994;93:460–469; discussion 470–461.CrossRefPubMed
29.
Christante D, Pommier SJ, Diggs BS, et al. Using complications associated with postmastectomy radiation and immediate breast reconstruction to improve surgical decision making. Arch Surg. 2010;145:873–878.CrossRefPubMed
30.
Sbitany H, Wang F, Peled AW, et al. Immediate implant-based breast reconstruction following total skin-sparing mastectomy: defining the risk of preoperative and postoperative radiation therapy for surgical outcomes. Plast Reconstr Surg. 2014;134:396–404.CrossRefPubMed
31.
Berry T, Brooks S, Sydow N, et al. Complication rates of radiation on tissue expander and autologous tissue breast reconstruction. Ann Surg Oncol. 2010;17 Suppl 3:202–210.CrossRefPubMed
32.
Tsoi B, Ziolkowski NI, Thoma A, et al. Safety of tissue expander/implant versus autologous abdominal tissue breast reconstruction in postmastectomy breast cancer patients: a systematic review and meta-analysis. Plast Reconstr Surg. 2014;133:234–249.CrossRefPubMed
33.
Aryus B, Audretsch W, Gogolin F, et al. Remission rates following preoperative chemotherapy and radiation therapy in patients with breast cancer. Strahlenther Onkol. 2000;176:411–415.CrossRefPubMed
34.
Ataseven B, Lederer B, Blohmer JU, et al. Impact of multifocal or multicentric disease on surgery and locoregional, distant and overall survival of 6,134 breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol. 2015;22(4):1118–27.CrossRefPubMed
35.
Boughey JC, McCall LM, Ballman KV, et al. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg. 2014;260:608-614; discussion 614–606.CrossRefPubMedPubMedCentral
36.
Luangdilok S, Samarnthai N, Korphaisarn K. Association between pathological complete response and outcome following neoadjuvant chemotherapy in locally advanced breast cancer patients. J Breast Cancer. 2014;17:376–385.CrossRefPubMedPubMedCentral
37.
Mombelli S, Kwiatkowski F, Abrial C, et al. Prognostic factors in operable breast cancer treated with neoadjuvant chemotherapy: towards a quantification of residual disease. Oncology. 2015;88(5):261–72.CrossRefPubMed
38.
Tan QX, Qin QH, Yang WP, et al. Prognostic value of Ki67 expression in HR-negative breast cancer before and after neoadjuvant chemotherapy. Int J Clin Exp Pathol. 2014;7:6862–6870.PubMedPubMedCentral
39.
Kaidar-Person O, Kuten A, Belkacemi Y; AROME. Primary systemic therapy and whole breast irradiation for locally advanced breast cancer: a systematic review. Crit Rev Oncol Hematol. 2014;92:143–152.CrossRefPubMed
40.
Bear HD, Anderson S, Smith RE, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2006;24:2019–2027.CrossRefPubMed
Metadata
Title
A Prospective Study on Skin-Sparing Mastectomy for Immediate Breast Reconstruction with Latissimus Dorsi Flap After Neoadjuvant Chemotherapy and Radiotherapy in Invasive Breast Carcinoma
Authors
Cécile Zinzindohoué, MD
Pierre Bertrand, MD
Aude Michel, PhD
Emilie Monrigal, MD
Bernard Miramand, MD
Nicolas Sterckers, MD
Christelle Faure, MD
Hélène Charitansky, MD
Marian Gutowski, MD
Monique Cohen, MD
Gilles Houvenaeghel, MD, PhD
Frederic Trentini, MD
Pedro Raro, MD
Jean-Pierre Daures, MD, PhD
Sandy Lacombe, MA
Publication date
01-07-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 7/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5146-y

Other articles of this Issue 7/2016

Annals of Surgical Oncology 7/2016 Go to the issue

Endocrine Tumors

Epigenetic Alterations and Canonical Pathway Disruption in Papillary Thyroid Cancer: A Genome-wide Methylation Analysis

Melanomas

The Diagnostic Value of PET/CT Imaging in Melanoma Groin Metastases

Bone and Soft Tissue Sarcomas

Analysis of Clinical and Molecular Factors Impacting Oncologic Outcomes in Undifferentiated Pleomorphic Sarcoma

Breast Oncology

Is Sentinel Lymph Node Biopsy Indicated at Completion Mastectomy for Ductal Carcinoma In Situ?

Gynecologic Oncology

Laparoscopic Indocyanine Green Sentinel Lymph Node Mapping in Endometrial Cancer

Melanomas

Clinical Response and Regional Toxicity Following Isolated Limb Infusion Compared with Isolated Limb Perfusion for In-Transit Melanoma