P&S Journal: Winter 1998, Vol.18, No.1
Recommendations For Locally Advanced Breast Cancer
A new study suggests that immediate breast reconstruction after mastectomy in patients with locally advanced breast cancer is safe and provides important psychological benefits.
Immediate reconstruction is offered routinely to women with early-stage breast cancer. Oncologists have been reluctant to offer immediate reconstruction to patients with more advanced disease because they require preoperative chemotherapy that can cause complications with wound healing and infections, possibly delaying the resumption of postoperative chemotherapy.
However, since the psychological, practical, and technical benefits that immediate reconstruction provides in early-stage disease are so well-established, we felt it necessary to attempt to expand its use to those with locally advanced disease," says study leader Dr. Mark Sultan, assistant professor of surgery.
In the study, 22 patients with locally advanced breast cancer (stage IIB or III) underwent mastectomy and immediate breast reconstruction. Eight patients received saline-filled implants, 13 were reconstructed with their own tissue, and one reconstruction used both an implant and the patient's own tissue.
Three of the women suffered minor postoperative complications, a morbidity rate comparable with that found in patients with early-stage disease who do not undergo preoperative chemotherapy. A fourth patient developed an implant-related infection six months after the operation.In no instance did these or other events lead to a delay in the resumption of chemotherapy postoperatively," reports Dr. Sultan. In addition, the reconstructions did not interfere with monitoring for recurrent disease.
Because of the study's small size, no definitive conclusions can be made. "We cannot yet advocate reconstruction in every case." Decisions must be made case by case, with input from the patient and her entire health care team. However, Dr. Sultan says, "This concept is generally safe and therefore deserves further study.
The study was published in the April 1997 issue of Annals of Plastic Surgery. The other investigators were Dr. Mark L. Smith, Dr. Alison Estabrook, Dr. Freya Schnabel, and Dr. Davinder Singh.