Reconstruction of Patients with Stage IV Breast Cancer
Malke Asaad, Tanya Hoskin, Tina Hieken, Jorys Martinez-Jorge, Nho Tran, Minh-Doan Nguyen, Jennifer Yonkus, Judy Boughey, Amy Degnim.
Mayo Clinic, Rochester, MN, USA.
BACKGROUND: Surgical intervention and reconstruction for patients with stage IV breast cancer is controversial. Improvements in modern systemic therapies have allowed increased life expectancy. The goal of this study is to report outcomes for stage IV breast cancer patients who undergo mastectomy and reconstruction.
METHODS: Using an institutional prospectively maintained breast surgery database, we identified all patients who presented with de novo stage IV breast cancer from January 2008 to December 2018. Patients were included if they underwent mastectomy with or without reconstruction. Patients who underwent mastectomy for palliative indications were excluded. Patients were grouped into Reconstruction (R), and No Reconstruction (NR) groups. Demographics, cancer characteristics, reconstructive techniques, complications, and survival were abstracted and analyzed.
RESULTS: A total of 32 patients were identified, among whom 8 underwent reconstruction (R), and 24 did not (NR). All patients in the NR group underwent simple mastectomy. In the R group, reconstruction was immediate in 5 (62.5%), 4 with skin-sparing mastectomy and 1 nipple-sparing mastectomy. The 3 patients with delayed reconstruction (37.5%) had simple mastectomy, with mean time of 26 months until reconstruction. Reconstructive techniques included tissue expanders (TE) followed by implant placement (n=5), autologous reconstruction (n=1), Goldilocks procedure (n=1), and fat injection (n=1). Median time from diagnosis to mastectomy was similar between the two groups (9 months). Two complications were identified in the R group (25%); one patient had implant displacement, and another patient developed hematoma and focal mastectomy skin flap necrosis. Both required reoperation. In the NR, complication rate was 29% (n=7, 5 seromas, 1 malignant hyperthermia, 1 hematoma). Median survival in the whole cohort was 117 months, while the median length of follow-up was 40 months (range, 6-189). Five-year survival was 64% in the NR and 100% in the R groups (p=0.04). Compared to the NR group, patients in the R group had smaller median pathologic tumor size (0.2 cm in R, 3.8 cm in NR, p=0.003), fewer median number of positive nodes (0 in R, 2 in NR, p=0.0496), and better distant metastasis response to neoadjuvant systemic therapy (88% had complete or partial response in R, 70% in NR). CONCLUSIONS:Mastectomy and reconstruction is reasonable to consider in highly selected patients with stage IV breast cancer who have excellent response to systemic therapy and anticipated durable survival. Further studies should assess differences in quality of life in patients with stage IV breast cancer with and without reconstruction.
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