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12/08/03 - SABCS: Post-Surgical Breast Reconstruction Also Safe for Women With More Advanced Disease - Doctor's Guide

By Bruce Sylvester

SAN ANTONIO, TX -- December 8, 2003 -- Skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) after mastectomy have recurrence and metastatic rates comparable to non-reconstructive surgery, even in high-risk cases, researchers reported here December 5th at the 26th Annual San Antonio Breast Cancer Symposium.

"This is a long-term outcome study looking at local recurrence with immediate breast reconstruction using a skin-sparing mastectomy," said co-investigator Iain Brown, MD, former oncoplastic fellow at Canniesburn Hospital of the University of Glasgow in Glasgow, UK, and currently medical resident at the University of Manchester in Manchester, UK. "The importance of this study is that, up until now, studies looking at the safety of immediate breast reconstruction have focused on a select group of patients with early stage disease, maybe even in situ breast cancer. Looking at how safe these procedures are with that group is an entirely different thing than looking at the whole spectrum of patients. There has been a tendency among reconstructive surgeons to be a little bit tentative about whom they will offer immediate reconstruction to. Therefore, those patients who have worse breast cancer may not get an immediate breast cancer reconstruction."

"What we have done here is that we have used the fact that in the west of Scotland we will do an immediate breast reconstruction on any patient that requires a mastectomy," Dr. Brown continued. "If they need to have neo-adjuvant chemotherapy first, then they can have that and then have their reconstruction as an immediate procedure. And that is new. In our study, three-fourths of our patients have had at least a moderate or high Nottingham prognostic score - that is, they have more advanced disease."

The investigators identified prospectively 255 patients who underwent IBR between 1995 and 2000. They received follow-up data from the Greater Glasgow Health Board Audit of operable breast cancers. They verified the data with case-note and pathological review.

They noted that 151 of the subjects underwent IBR and SSM for invasive disease - 63 for ductal carcinoma in situ, 23 for prophylaxis and seven for congenital abnormalities. Of the subjects with invasive disease, 27 had expander/implant reconstruction, 89 had a latissimus dorsi flap (63 autologous, 26 with implant), and 35 had a free-flap reconstruction.

At 48-months median follow-up (range, 14-86 months), the investigators found that 86% of the patients from the invasive cancer subgroup were disease free; three patients had developed local recurrence; 10 patients had developed axillary or supraclavicular recurrence, and nine patients had systemic metastases. There had been 10 deaths (6.6%), with a median time to death of 25 months (range, 10-71).

"We are showing that this is a safe procedure even in advanced disease with local recurrence rates that are low within the established literature - and are comparable with a standard mastectomy without a reconstruction," concluded Dr. Brown. "So this is a paper which has good follow-up, reasonably large numbers, and has a broad spectrum of breast disease. We are showing that immediate breast reconstruction is safe."