Background: Locoregional recurrence of the
previously reconstructed breast poses a diagnostic and operative challenge.
This study examines detection, management, and reconstructive strategies of
locoregional recurrence following postmastectomy breast reconstruction.
Methods: A retrospective review of
records was performed on patients treated within the health system for breast
cancer from January of 2000 to July of 2014. Of these patients, descriptive
factors and operative details were collected for those that developed
locoregional recurrence. Subsequent reconstructive operations were also
examined. Using a multidisciplinary team, a surveillance/management algorithm
was generated.
Results: A total of 41 patients with
locoregional recurrence were identified (mean time to recurrence, 4.6 years).
Two- and 5-year survival following locoregional recurrence was 88 percent and 39
percent, respectively. Locoregional recurrence 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 locoregional recurrence (p = 0.028), increased time to
recurrence/detection (p = 0.024), and chemotherapy before locoregional
recurrence (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 body mass index (p = 0.009), pectoralis
invasion (p = 0.05), and implant reconstruction (p = 0.03).
Conclusions: Detection and management of
locoregional recurrence requires appropriate physical examination and imaging.
Significant factors associated with failure to salvage the initial
reconstruction included body mass index, plane of recurrence, and type of
initial reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
