Abstract
Background: The management of stage III breast cancer is challenging; it often includes multimodal treatment with systemic therapy and/or radiation therapy and surgery. Immediate breast reconstruction has not traditionally been performed in these patients. We review the results of immediate transverse rectus abdominis musculocutaneous (TRAM) flap in 21 patients treated for stage III breast cancer.
Methods: Data have been collected retrospectively on 21 patients diagnosed with stage III breast cancer between 1987 and 1994. All patients had mastectomy and immediate TRAM reconstruction. Thirteen patients received primary systemic therapy, 10 patients received postoperative consolidation radiotherapy to the operative site, and 3 patients received preoperative radiation.
Results: Mean follow-up for the group was 26 months. Two patients died with disseminated disease: neither of them developed local disease recurrence in the operative site; 82% of the patients followed for at least two years are free of disease. Sixty-two percent of the patients received preoperative chemotherapy, the remaining patients received postoperative multiagent chemotherapy and/or radiation therapy. Two of the patients received autologous bone marrow transplants after their adjuvant therapy. Ten patients had postoperative radiotherapy for consolidation; three patients received preoperative radiation.
Conclusions: Immediate TRAM reconstruction for stage III breast cancer is not associated with a delay in adjuvant therapy or an increased risk of local relapse. It facilitates wide resection of involved skin without skin grafting. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of stage III breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.
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Hortobagyi GN. Comprehensive management of locally advanced breast cancer.Cancer 1993;66:1387–91.
Armstrong DK, Fetting JH, Davidson NE, Gordon GB, Huelskamp AM, Abeloff MD. Sixteen week dose intense chemotherapy for inoperable, locally advanced breast cancer.Breast Cancer Res Treat 1993;28:277–84.
Zucali R, Uslenghi C, Kenda R, Bonadonna G. Natural history and survival of inoperable breast cancer treated by radiotherapy and radiotherapy followed by radical mastectomy.Cancer 1976;37:1422–31.
Swain SM, Sorace RA, Bagley CS, Danforth DN Jr, Bader J, Wesleay MN, et al. Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer.Cancer Res 1987;47:3889–94.
Singletary SE, McNeese MD, Hortobagyi GN. Feasibility of breast conservation surgery after induction chemotherapy for locally advanced breast carcinoma.Cancer 1992;69:2849–52.
Perez CA, Graham ML, Taylor ME, Levy JF, Mortimer JE, Philpott GW, Kucik NA. Management of locally advanced carcinoma of the breast. I. Noninflammatory.Cancer 1994,74(suppl 1):453–65.
Elliott LF, Eskenazi L, Beegle PH Jr, Podres PE, Drazan L. Immediate TRAM flap breast reconstruction: 128 consecutive cases.Plast Reconstr Surg 1993;92:217–27.
Jacobsen WM, Meland NB, Woods JE. Autologous breast reconstruction with use of transverse rectus abdominis musculocutaneous flap: Mayo Clinic experience with 147 cases.Mayo Clin Proc 1994;69:635–40.
American Joint Committee for Cancer Staging and End-results Reporting.Manual for staging of cancer. Chicago: American Joint Committee, 1977:101.
Elston C. Grading of invasive carcinoma of the breast. In: Page D, Anderson T, eds.Diagnostic histopathology of the breast. Edinburgh: Churchill Livingston, 1987:300–11.
Banic A, Boeckx W, Greulich M, Guelickx P, Marrchi A, Rigotti G, Tschopp H. Late results of breast reconstruction with free TRAM flaps: a prospective multicentric study.Plast Reconstr Surg 1995;95:1195–206.
Robbins TH. Rectus abdominis myocutaneous flap for breast reconstruction.Aust NZ J Surg 1979;49:527–30.
Dinner MI, Labandter HP, Dowden RV. The role of the rectus abdominis myocutaneous flap in breast reconstruction.Plast Reconstr Surg 1982;69:209–15.
Watterson PA, Bostwick J, Hester TR, Bried JT, Taylor GI. TRAM flap anatomy correlated with a 10 year clinical experience with 556 patients.Plast Reconstr Surg 1995;95:1185–94.
Loprinzi CL, Carbone PP, Tormey DC, Rosenbaum PR, Caldwell W, Kline JC, Steeves RA, et al. Aggressive combined modality therapy for advanced local-regional breast carcinoma.J Clin Oncol 1984;2:157–63.
Schwarz GF, Cantor RI, Biermann WA. Neoadjuvant chemotherapy before definitive treatment of stage III carcinoma of the breast.Arch Surg 1987;122:1430–4.
Hortobagyi GN, Amers FC, Buzdar MD, Kau SW, McNeese MD, Paulus D, Hug MD, et al. Management of stage III primary breast cancer with primary chemotherapy, surgery and radiation therapy.Cancer 1988;62:2507–16.
Slavin SA, Love SM, Goldwyn RM. Recurrent breast cancer following immediate reconstruction with myocutaneous flaps.Plast Reconstr Surg 1994;93:1191–204.
O'Brien W, Hasselgren PO, Hummel RP, Coith R, Hyams D, Kurtzman L, Neale HW. Comparison of postoperative wound complications and early cancer recurrence between patients undergoing mastectomy with or without immediate breast reconstruction.Am J Surg 1993;166:1–5.
Fowble B, Schwarbold F. Local regional recurrence following definitive treatment for operable breast cancer. In Fowble B, Goodman R, Glick J, Rosato E, eds.:Breast cancer treatment. St. Louis: Mosby Year Book, 1991:373–402.
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Styblo, T.M., Lewis, M.M., Carlson, G.W. et al. Immediate breast reconstruction for stage III breast cancer using transverse rectus abdominis musculocutaneous (TRAM) flap. Annals of Surgical Oncology 3, 375–380 (1996). https://doi.org/10.1007/BF02305667
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DOI: https://doi.org/10.1007/BF02305667