Wednesday, November 6, 2002 - 8:18 AM

Immediate Free Flap Reconstruction of Locally Advanced Breast Cancer: A Ten-Year Review

Babak Joseph Mehrara, MD, Andrew Smith, MD, Eric Arcilla, MD, Timothy Santoro, MD, Jeffery Sebastian, MD, James Watson, MD, Andrew Da Lio, MD, and William Shaw, MD.

Introduction: Immediate reconstruction (IBR) of locally advanced breast cancer (LABC) is controversial. In an effort to avoid delays in adjuvant therapy, many oncologic surgeons advise their patients to delay reconstruction. The purpose of this study was to evaluate the safety and efficacy of IBR in patients with LABC. Methods: The records of 766 consecutive patients treated over the last 10-year period were reviewed. Patients with the diagnosis of stage IIB or worse breast cancer were identified and analyzed. Results: 170 patients with LABC who underwent IBR were identified (57 IIB; 63 IIIA; 39 IIIB; 11 IV). There were 158 unilateral and 12 bilateral reconstructions (182 flaps). The TRAM flap was used in the vast majority (158). The average age was 48 and 24% of patients had comorbid conditions. The average hospital stay was 5.1 days, and 23 patients required banked blood transfusions. There were 7 major complications (4.1%; 1 complete flap loss; 2 partial flap losses, 1 arterial and 1 venous thrombosis, both of which were salvaged, and 2 hematomas). There were 70 minor complications (41%; 9 infections, 33 patients with fat necrosis; 9 hernias or abdominal wall laxities; 4 minor fluid overload, and 13 donor site complications). Adjuvant postoperative therapy was delayed in 8 patients (5%), and the maximum delay was 3 weeks (one patient). The incidence of impaired wound healing and subsequent delay in postoperative adjuvant chemotherapy compared favorably to mastectomy without reconstruction in this population. Discussion: In the largest series to date, we have shown that IBR in the setting of locally advanced breast cancer is safe, well tolerated, and not associated with significant delays in adjuvant therapy. These findings, together with the known psychological benefits and convenience of IBR make a strong argument for immediate reconstruction in otherwise healthy patients regardless of cancer stage.
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