Skin-Sparing Mastectomy and Immediate Breast Reconstruction in the Management of Locally Recurrent Breast Cancer

To investigate whether skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is a possible treatment option in selected cases of locally recurrent breast cancer after previous breast-conserving therapy (BCT). Sixty consecutive patients were treated by SSM and IBR between 1995 and 2008 for ipsilateral breast tumour recurrence (IBTR). Selection criteria consisted of: IBTR < 3 cm size, not infiltrating skin or chest wall, primarily node negative, recurrence > 3 years after primary operation, and no metastases. Patient records were analysed retrospectively and follow-up data on patient outcome included. The reconstruction method consisted of 40 free abdominal flaps, 18 latissimus dorsi (LD) flaps with or without an implant, and two cases of implant only. Twenty-three patients received adjuvant oncological therapy. During median follow-up of 66 months, 11 patients (18%) developed disease relapse, including 6 (10%) local re-recurrences. IBR is a possible treatment option for patients who develop local recurrence following earlier BCT. Our local re-recurrence rate of 10% compares well with that following salvage mastectomy for IBTR. Of patients, 43% did not actually meet our selection criteria but yet appeared to fare well in terms of outcome. Therefore we should re-evaluate our selection criteria.