Locoregional cancer recurrence after breast reconstruction: detection, management, and secondary reconstructive strategies.

Purpose: Locoregional recurrence (LRR) of the previously reconstructed breast poses a diagnostic and operative challenge. This study examines detection, management, and reconstructive strategies of LRR following post-mastectomy breast reconstruction. Methods: A retrospective review of records was performed on patients treated within the health system for breast cancer from January 2000 – July 2014. Of these patients, descriptive factors and operative details were collected for those that developed LRR. Subsequent reconstructive surgeries were also examined. Utilizing a multidisciplinary team, a surveillance/management algorithm was generated. Results: A total of 41 patients with LRR were identified (mean time to recurrence 4.6 years). 2-year and 5-year survival following LRR was 88 percent and 39 percent respectively. LRR was found to occur in the following tissue planes: subcutaneous (27 percent), subcutaneous/pectoralis (24 percent), chest wall (37 percent), and axillary (12 percent). The most frequent method of detection was patient concern leading to examination. Older age at the time of LRR (p=0.028), increased time to recurrence /detection (p=0.024), and chemotherapy before LRR (p=0.014) were associated with the need for a secondary salvage flap. Patients who experienced a subcutaneous recurrence were far less likely to undergo a secondary flap (p=0.011). Factors associated with loss of the index reconstruction included lower BMI (p=0.009), pectoralis invasion (p=0.05), and implant reconstruction (p=0.03). Conclusions: Detection and management of LRR requires appropriate physical exam and imaging. Significant factors associated with failure to salvage the initial reconstruction included BMI, plane of recurrence and type of initial reconstruction. Presented at the annual meeting of the American Society for Reconstructive Microsurgery, in Scottsdale, Arizona January 16th through 19rd, 2016 Acknowledgements : The authors would like to thank Marten Basta MD and Michael Chu MD for their contributions to the study as well. ** None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding Author:Suhail Kanchwala, M.D., Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, South Pavillion – 14th floor, 3400 Civic Center Blvd., Philadelphia, PA 19104, Suhail.Kanchwala@uphs.upenn.edu ©2019American Society of Plastic Surgeons

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