Locally-Advanced Ulcerative T4b Breast Cancer; Are Reconstructive Attempts Feasible?

Purpose: A subset of women with locally-advanced breast cancer present with fungating tumor mass eroding and infiltrating the surrounding breast skin (T4b breast cancers). These patients often present with chronic pain, large open wounds, frequent infections, malodorous drainage, social isolation, and general debilitation that present enormous therapeutic challenges. Due to the advanced nature of the disease, palliation while minimizing recovery time and maximizing quality of life is essential.

Methods:  From 2009 to 2014, twelve consecutive patients underwent resection of fungating T4b breast tumors and subsequent chest wall reconstruction. Demographic, socioeconomic, and clinical data were collected retrospectively. 

Results:  50% of women had distant metastases at time of reconstruction, and 17% of women presented to the emergency department hemodynamically unstable in either hemorrhagic or septic shock necessitating delay of reconstruction for up to a week. Mean wound size for reconstruction was 473 cm2. Reconstructive procedures included split-thickness skin grafting and thoracoepigastric advancement, latissimus dorsi, trapezius, and extended transverse & vertical rectus abdominis flaps. Three of these patients are deceased (survival 98-172 days, mean of 127 days). 75% of patients had improved pain and reduced wound care needs after reconstruction. Post-operative reconstruction specific complications occurred in 33% of cases with one patient requiring a second OR visit.

Conclusions:  Women with fungating T4b breast cancer tumors often present with metastatic disease and have significant need for pain and wound palliation. The reconstructive techniques performed are reliable, efficacious in palliating pain and reducing wound care needs, and have low complication rates.