The AAPS 101st Annual Meeting

Impact of Breast Reconstruction Modality on Breast Cancer Recurrence Detection

Helen S. Zitkovsky, MD,1 Haley Desjardins, MD,2 Michael M. Jonczyk, MD, MS1, Miguel I. Dorante, MD, MBE1,

Yoon Sun Chun, MD3, and Lifei Guo, MD, PhD1

Background:

5-year breast cancer locoregional recurrence rate ranges from 4-11%
Scant literature evaluating long-term recurrence rates in patients with prosthetic versus autologous reconstruction
Objective: Evaluate the impact of reconstructive modality on oncologic outcomes including: locoregional recurrence rate, time to detection, and size of detection

Methods:

Retrospective cohort analysis (1990 - 2010)
Excluded: <18 y.o., prior breast surgery, inflammatory cancer, latissimus dorsi flap reconstruction
Kaplan-Meier curve estimated cumulative incidence of locoregional recurrence at time intervals:
Less than 13, 13-18, more than 18 years
Cox proportion hazard model stratified by time for time to recurrence analysis

Results:

Primary tumors in autologous group were larger and with a trend towards more advanced stage
No difference between chemotherapy or radiation treatment between groups
Higher overall autologous long-term recurrence rate
Locoregional recurrence detected on average 700 days later in autologous group
Autologous recurrences larger, more advanced stage, and with higher mortality at detection
Stratified by time:
Similarly low recurrence rate until approximately 13 yr in both groups
13-18 yr: Prosthetic group with increased incidence of recurrence
Suggesting higher detection during this period on prosthetic reconstructions

Conclusion:

Autologous flap reconstruction appears to delay the detection of recurrence
May be due to the masking of the entire breast footprint
Subpectoral prosthetic reconstruction superficializes much of the posterior breast margin, enabling clinical detection of recurrence
Consider increased long-term surveillance in autologous reconstruction patients

Impact Of Breast Reconstruction Modality On Breast Cancer Recurrence Detection