(OA27) Outcome in Patients Treated With Partial Breast Reconstruction or Bilateral Reduction Mammoplasty at the Time of Breast Conserving Surgery (BCS) Followed by Whole Breast Radiation Therapy (WBRT)

Abstract

Lumpectomy/ partial mastectomy may result in asymmetry of the treated breast relative to the unaffected breast. Volume loss is the most common cause of the negative cosmetic outcome in patients undergoing BCS. To help improve cosmetic results the practice of breast oncoplasty at the time of lumpectomy ± sentinel node surgery is gaining popularity. In this paper, we report our experience on patients who underwent autologous flap partial breast reconstruction or bilateral reduction mammoplasty at the time of BCS. Postoperatively, all patients received WBRT. The objective of the study was to evaluate cosmetic outcomes and local control. In addition, we sought to study the incidence for the recommendations of BIRADS 3 or 4, and fat necrosis on follow up mammograms and sonograms. In this retrospective study, we identified 24 breast cancer patients who at the time of BCS either underwent partial breast reconstruction using autologous flap or had bilateral reduction mammoplasty. Postoperatively, all patients received WBRT to a dose ranging from 50.4Gy to 60Gy. Adjuvant systemic therapy was prescribed at the discretion of the treating oncologist. In follow up, all patients were seen at regular intervals by the multidisciplinary team, and mammograms and directed sonograms were obtained at scheduled intervals. A total of 27 breasts in 24 patients (3 bilateral) are included in this review. The median follow up is 48 months (range: 4 months to 79 months). The median age is 52 years (range: 29 to 71 years). The pathologic stage distribution was: 7 stage 0, 13 stage I, 5 stage II, and 2 had stage ypT0N0M0 having presented with clinical stage IIB and undergone BCS following neoadjuvant therapy. All but 1 patient had negative resections margins. The median number of excisions to achieve clear margins was 2 (range 1 to 3). Fifteen patients underwent bilateral reduction mammoplasty, while 9 had either thoracodorsal artery perforator flap (TDAP), lateral intercostal artery perforator flap (LICAP), or other autologous free flaps. Twenty patients also received systemic chemotherapy and/or hormonal therapy. Cosmetic results in the majority were excellent/very good. In follow up we observed that 4 patients underwent additional revisions for cosmetic indications; and 3 of the 4 patients were among those who had partial breast reconstruction using free-flaps. Follow up mammography noted recommendation of BIRADS 3 and 4 in 3/27 (11.1%) and 2/27 (7.4%) breasts, respectively. Additionally, 5/27 (18.5%) had radiographic evidence of fat necrosis. No patient has developed a local recurrence. In the multidisciplinary care of breast cancer the integration of plastic surgery procedures is increasingly gaining acceptance. We observed that partial breast reconstruction as an adjunct to BCS prior to WBRT results in excellent cosmetic result and local control. Radiographically, the incidence of fat necrosis was the most common finding and the recommendation for BIRADS 4 was low. In select cases, partial breast reconstruction at the time of BCS prior to WBRT may be a reasonable approach to offset the volume loss of an extensive lumpectomy.