Increase of Fat Necrosis after Radiation Therapy Following Mastectomy and Immediate TRAM Flap Reconstruction in High-risk Breast Cancer Patients.
10.4048/jkbcs.2004.7.1.17
- Author:
Byung Ho SON
1
;
Taek Jong LEE
;
Sang Wook LEE
;
Ui Kang HWANG
;
Beom Seok KWAK
;
Sei Hyun AHN
Author Information
1. Department of Surgery, College of Medicine, University of Ulsan and Asan Medical Center, Seoul, Korea. brdrson@korea. com
- Publication Type:Original Article
- Keywords:
Breast cancer;
Skin-sparing mastectomy;
Immediate TRAM flap reconstruction;
Radiation therapy;
Fat necrosis
- MeSH:
Breast Neoplasms*;
Breast*;
Chungcheongnam-do;
Fat Necrosis*;
Follow-Up Studies;
Humans;
Mastectomy*;
Necrosis;
Rectus Abdominis;
Recurrence;
Retrospective Studies
- From:Journal of Korean Breast Cancer Society
2004;7(1):17-21
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: This study evaluated the benefit of radiation therapy in high-risk breast cancer patients who have received immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. The evaluation involved examining the effect of radiation therapy on postmastectomy flap fat necrosis and tumor recurrence. METHODS: A retrospective review was performed on 102 patients who underwent mastectomy and immediate TRAM flap reconstruction between 1996 and 2001 at the Asan Medical Center (Seoul, Korea). The mean patient age was 41 years, and the median follow-up time was 33 months. Skin-sparing mastectomy was con ducted in 82 patients (80.4%) and classical mastectomy in 20 patients (19.6%). Of the 21 high-risk patients needing postmastectomy radiation therapy, nine received it. RESULTS: Moderate or severe TRAM flap fat necrosis occurred more frequently in patients receiving radiation therapy than those not receiving radiation therapy (55.6% vs. 19.4%, P=0.026). In the group with high-risk patients, two tumor recurrences occurred (one-locoregional and one-systemic). Among the 102 patients, thirteen had recurrences, including only two high-risk patients, with almost of them being systemic recurrences except four locoregional recurrences. CONCLUSION: Our findings showed that radiation therapy increased flap fat necrosis in high-risk patients underwent immediate TRAM flap reconstruction. Such necrosis can result in poor outcomes for reconstruction. We recommend careful consideration prior to using radiation therapy on high-risk breast cancer patients after immediate TRAM flap reconstruction, where clinicians need to balance the possible positive effects on recurrence with the possible negative effects on flap tissue.
