Abstract P6-18-02: Patterns of breast reconstruction in patients diagnosed with inflammatory breast cancer
Authors: Nakhlis F , Regan M , Chun YS , Dominici LS , Jacene HA , Yeh ED , Bellon JR , Warren LE , Hirko K , Hirshfield-Bartek J , Hazra A , Overmoyer BA 
Published: May 2016

Background Inflammatory Breast Cancer (IBC) is a rare and aggressive type of breast cancer treated by multimodality therapy. Due to the presence of dermal lymphatic involvement by disease it is unknown whether a skin sparing mastectomy (SSM) would be safe, even after completion of preoperative chemotherapy, therefore immediate breast reconstruction (BR) following modified radical (MRM) is discouraged. We sought to explore the patterns of BR outcomes in IBC patients (pts) and to evaluate their surgical outcomes.

Methods A retrospective analysis was performed using an IRB-approved database of IBC pts evaluated at Dana Farber Cancer Institute (DFCI) from 1997 until 2014. Pts with stage III IBC who received preoperative systemic therapy followed by MRM and post-mastectomy radiation (PMRT) were analyzed. Receipt and timing of BR, post-operative morbidity and subsequent esthetic issues were collected. We also analyzed oncologic events which may have hindered receipt of BR.

Results 318 pts were enrolled in the IBC registry at DFCI between 1997 and 2014. 181 pts with stage III IBC were identified, with a median follow-up of 57 months (mo) from MRM. 33/181 pts (18%) underwent BR; 2 pts were not evaluable due to lack of details concerning BR. 12 pts had immediate BR, 10 of which were performed elsewhere, prior to initial evaluation at DFCI. These included 3 tissue expander (TE) reconstructions, 3 single stage implants, 1 deep inferior epigastric perforator (DIEP) flap, 4 transverse rectus abdominis myocutaneous (TRAM) flaps, 1 latissimus dorsi (LD) flap. 19 had delayed BR. These included 1 TE, 5 DIEP flaps, 2 LD flap, 1 TE+LD flap, 10 TRAM flaps. Delayed BR occurred at a median of 13 mo (range 3-64 mo) following completion of PMRT.

Complications post-BR were rare. Among the immediate BR pts, 1 pt with a TRAM flap BR required a reoperation 15 days (d) following BR for a partial TRAM flap necrosis. Among the delayed BR pts, one had a reoperation for abdominal TRAM flap donor site wound dehiscence 29 d after BR. Another delayed BR pt, who had a TE+LD flap BR, had her reconstruction implant removed due to chronic hematoma 79 mo after her initial BR; this occurred following 3 operative attempts to salvage her reconstruction by evacuating the hematoma. Overall, 12 reoperations were performed including 6 immediate BR (6/19 (31.6%) and 6 delayed BR pts (6/12 (50.0%); 6 of these reoperations (50%) were done for minor esthetic issues, such as reconstruction revisions for fat necrosis and capsular contracture, in addition to the more significant surgeries described above. Among 148 pts who did not undergo BR, 69 (47%) had disease recurrence following MRM (66 distant +/- local-regional recurrence (LRR); 3 LRR only); within 12 mo of MRM disease recurrence developed in 22% of pts (33/148).

Conclusion Only 11% of pts presenting with stage III IBC recieved delayed BR in this retrospective analysis of 181 pts. The majority of these pts achieved successful BR, except for 1 pt. It is possible that BR was not sought more frequently due to a fairly high rate of distant disease relapse (47% in this cohort). Further studies addressing the outcomes of BR in IBC pts are needed in order to assist in counseling pts regarding their reconstructive expectations.

Citation Format: Nakhlis F, Regan M, Chun YS, Dominici LS, Jacene HA, Yeh ED, Bellon JR, Warren LE, Hirko K, Hirshfield-Bartek J, Hazra A, Overmoyer BA. Patterns of breast reconstruction in patients diagnosed with inflammatory breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-18-02.