RECONSTRUCTION IN LOCALLY ADVANCE BREAST CANCER: WHO, WHAT AND WHEN?

BACKGROUND: Locally advanced breast cancer (LABC) is defined as the most advanced stage of non-metastatic breast cancer. While breast reconstruction is not contraindicated in this subset of patients, the decision-making process is influenced by several considerations, including recurrence risk and the need for and timing of adjuvant therapy such as radiotherapy. This retrospective analysis investigates the reconstructive procedures performed on women presenting with locally advanced breast cancer at the Netcare Breast Care Centre (NCBC) in Johannesburg.

METHOD: Patients with LABC who underwent breast reconstruction were identified from a database of breast cancer patients presenting to the NCBC during a 1 year period (June 2015 - June 2016). Data collected included demographic details, histology and details regarding surgery and reconstructive procedures.

RESULTS: Of the 28 patients initially identified, 6 were excluded due to incomplete information. The remaining 22 patients were all female, with a median age of 60 years (range 24-72 years). The majority (18/22) of the patients presented with infiltrating ductal carcinoma and the luminal B subtype predominated (12/22). Nineteen patients were initiated on neoadjuvant therapy prior to surgery. Breast conservation therapy was possible in 13 patients, the rest underwent mastectomy. Immediate reconstruction was performed in 13/22 patients and immediate-delayed reconstruction in 9/22. All 22 patients in the study group had autologous tissue reconstruction, and the majority (17/22) had a procedure on the contralateral breast at the same time.

CONCLUSION: At the NCBC, autologous reconstruction as an immediate or immediate-delayed procedure is the preferred reconstructive strategy in LABC.