Is Immediate Breast Reconstruction With a Latissimus Dorsi Myocutaneous Flap Safe for Starting Adjuvant Chemotherapy in Patients With Breast Cancer?

INTRODUCTION: Immediate breast reconstruction following mastectomy reduces perceptions of mutilation and femininity issues in oncological patients, but surgical complications should not delay chemotherapy. This study evaluated postsurgical complications in patients who underwent radical breast surgery followed by immediate reconstruction with latissimus dorsi myocutaneous flaps and silicone implants, along with resulting impacts in delaying chemotherapy. MATERIALS AND METHODS: This retrospective study utilized a prospectively maintained database. Clinical, surgical, and oncological data from 196 women were collected according to the operated side. Patients were grouped according to the time elapsed between surgery and the first cycle of adjuvant chemotherapy: ≤ 60 days (group 1), 61 to 90 days (group 2), or > 90 days (group 3). RESULTS: A total of 198 immediate reconstructions were performed on 196 patients between August 1, 2010 and March 31, 2020; after surgery, 47.4% had minor complications and 7.1% had major complications. Ninety-six patients (48.5%) received adjuvant chemotherapy. The mean time elapsed between surgery and the first chemotherapy cycle was 65.4 days (median: 59), with 52.7% of the patients assigned to group 1, 37.4% to group 2, and 9.9% to group 3. The occurrence of major postoperative complications significantly affected the start of chemotherapy (64.0 vs. 94.5 days; P = .044). Additionally, patients with 2 or more comorbidities were more likely to experience major complications (OR: 3.35; 95% CI: 1.03-10.95; P = .045) than those with 1 or 0. CONCLUSION: Major postoperative complications significantly delayed initiation of adjuvant chemotherapy in oncological patients who underwent radical breast surgery followed by immediate reconstruction with a latissimus dorsi myocutaneous flap and silicone implants.

Neoadjuvant chemotherapy impact on outcomes in immediate breast reconstruction with latissimus dorsi flap and silicone implant.

BACKGROUND AND OBJECTIVES: Neoadjuvant chemotherapy (NCH) has demonstrated efficacy in downsizing tumors and facilitating less extensive surgery. However, immediate breast reconstruction (IBR) after NCH has raised concerns regarding higher complication rates. This study evaluates the impact of NCH on outcomes following IBR with a latissimus dorsi flap and implant (LDI) after mastectomy. METHODS: Cases from a prospective maintained database were reviewed, and patients classified according to whether or not they received NCH. Risk factors and major and minor complications in both groups were then analyzed. RESULTS: Among the 196 patients who underwent 198 IBR procedures, 38.4% received NCH and 66.1% did not. The overall complication rate was 46.7% in the non-NCH group and 53.3% in the NCH group (p = 0.650). The presence of comorbidities increased the likelihood of any complication (odds ratio [OR]: 3.46; 95% confidence interval [CI]: 1.38-8.66; p = 0.008) as well as major complications (OR: 3.35; 95% CI: 1.03-10.95; p = 0.045). Although patients in the NCH group experienced more major complications (10.5% vs. 4.9%; p = 0.134) and early loss of breast reconstruction (3.9% vs. 0.8%; p = 0.128), these findings were not statistically significant. CONCLUSION: This study found no statistically significant association between NCH and higher risk of complications or loss of IBR with LDI after mastectomy.

Mamoplastia redutora modificada para otimização de abordagem oncológica: resultados iniciais e revisão da literatura / Modified reduction mammoplasty for optimization of oncological approach: initial results and literature review

Introdução: O câncer de mama é a segunda neoplasia mais comum entre as mulheres. A constante evolução científica tem permitido abordagens cirúrgicas cada vez menos invasivas, diminuindo a morbidade relacionada ao tratamento sem prejuízo oncológico. O objetivo deste artigo é mostrar os resultados cirúrgicos e a versatilidade da mamoplastia redutora com a técnica de Pitanguy modificada, para otimização da reconstrução imediata associada à cirurgia oncológica. Métodos: Apresentamos os casos de três pacientes submetidas à técnica proposta. A marcação da mama com diagnóstico de câncer é planejada seguindo os princípios da mamoplastia redutora descrita por Pitanguy. Porém, o triângulo de ressecção inferolateral é transposto para a área supratumoral. Ele pode ser posicionado da junção dos quadrantes laterais (JQL) até o quadrante superolateral (QSL) da mama oncológica. Resultados: As três pacientes foram submetidas à técnica descrita associada à mamoplastia de simetrização contralateral com a técnica de Pitanguy. Todas realizaram radioterapia adjuvante, associada ou não à quimioterapia. Duas pacientes evoluíram sem intercorrências e uma apresentou pequena necrose de 1x1cm na junção inferior dos retalhos na mama com câncer, que foi tratada de maneira conservadora sem atrasar o tratamento adjuvante. Todas seguem satisfeitas com o resultado estético. Conclusão: A técnica descrita mostrou-se uma boa alternativa para tumores localizados entre a JQL e o QSL da mama oncológica, proporcionando ressecções mais amplas e dessa forma ampliando a indicação de cirurgia conservadora e reduzindo a necessidade de cirurgia radical, com melhores resultados estéticos sem prejuízo do desfecho oncológico.

Introduction: Breast cancer is the second most common cancer among women. Constant scientific evolution has allowed increasingly less invasive surgical approaches, reducing treatment-related morbidity without cancer damage. The objective of this article is to show the surgical results and the versatility of reduction mammoplasty with the modified Pitanguy technique to optimize the immediate reconstruction associated with cancer surgery. Methods: We present the cases of three patients who underwent the proposed technique. Marking of the breast diagnosed with cancer is planned following the principles of reduction mammoplasty described by Pitanguy. However, the inferolateral resection triangle is transposed into the supratumoral area. It can be placed from the junction of the lateral quadrants (JLQ) to the superolateral quadrant (SLQ) of the oncological breast. Results: the three patients underwent the described technique associated with contralateral symmetrization mammoplasty with the Pitanguy technique. All were submitted to adjuvant radiation therapy, associated or not with chemotherapy. Two patients progressed without incident and one had a small necrosis of 1x1 cm at the flaps lower junction in the breast with cancer, which was treated conservatively without delaying the adjuvant treatment. All were satisfied with the aesthetic result. Conclusion: The described technique proved to be a good alternative for tumors located between the JLQ and the SLQ of the oncological breast. It provides broader resections and thus expands the indication for conservative surgery and reduces the need for radical surgery, with better aesthetic results without impairment of the cancer outcome

Reconstrução mamária imediata com retalho do músculo grande dorsal e implante de silicone / Immediate breast reconstruction with latissimus dorsi flap and silicone implant

Introdução: O primeiro tratamento eficaz para o câncer de mama foi descrito em 1894. A partir das décadas de 60 e 70, cirurgias menos agressivas foram desenvolvidas, sem prejuízos oncológicos. Com evolução histórica semelhante, o retalho do músculo grande dorsal (RMGD) foi introduzido em 1906. Contudo, apenas 70 anos após sua primeira descrição, ele ganhou popularidade como uma opção para as reconstruções mamárias. Método: Estudo clínico retrospectivo realizado por meio da coleta de dados de 22 pacientes submetidas à reconstrução mamária imediata com emprego do RMGD associado a implante de silicone durante o período de fevereiro de 2012 a dezembro de 2013. Resultados: Não houve necrose do retalho de grande dorsal ou perda da reconstrução mamária nos casos estudados. Foram observados 10 casos (45%) de seroma em região dorsal, 3 casos (14%) de necrose parcial da pele da mastectomia e 3 casos (14%) de deiscência parcial da ferida operatória. Não foram evidenciados fatores de risco com significância estatística para as complicações apresentadas. Ocorreram 4 casos (18,18%) de alterações de cobertura do implante, com atrofia muscular e cutânea, e 2 casos (9,09%) de contratura capsular. Apenas um caso não foi associado à radioterapia. Contudo, não houve significância estatística em relação à radioterapia adjuvante e às complicações tardias apresentadas (p = 0,635). Conclusão: O RMGD associado ao implante de silicone é uma opção segura e confiável para a reconstrução mamária imediata após mastectomias.

Introduction: The first effective breast cancer treatment was described in 1894. Less aggressive surgeries were developed in the 1960s and 70s, without increased mortality due to cancer. With similar historical evolution, the latissimus dorsi muscle flap (LDMF) procedure was introduced in 1906. Seventy years after its first description, LDMF gained popularity as an option for breast reconstruction. Method: A retrospective clinical study was conducted using data obtained from 22 patients undergoing immediate breast reconstruction with LDMF and silicone implants between February 2012 and December 2013. Results: No latissimus dorsi flap necrosis or breast reconstruction losses were observed in this study. Ten cases (45%) of seroma were detected in the dorsal region, three cases (14%) of partial necrosis of the mastectomized skin, and three cases (14%) of partial surgical wound dehiscence. Statistical significant risk factors for the complications observed have not been emphasized. There were four cases (18.18%) of muscle and skin atrophy associated with implants, and two cases (9.09%) of capsular contracture. Only one case was not associated with radiotherapy. However, there were no statistically significant differences in adjuvant radiotherapy and late complications (p = 0.635). Conclusion: LDMF associated with silicone implants is a safe and reliable option for immediate breast reconstruction after mastectomies.