Immediate breast reconstruction for women having inflammatory breast cancer in the United States

Abstract

Inflammatory breast cancer (IBC) is an aggressive malignancy having a poor prognosis. Traditionally, reconstruction is not offered due to concerns about treatment delay, margin positivity, recurrence, and poor long‐term survival. There is a paucity of literature, however, evaluating whether immediate breast reconstruction (IBR) is associated with greater mortality in patients with IBC. A population‐based study was conducted via the SEER‐Medicare‐linked database (1991‐2009). Female patients greater than 65 years were reviewed who had mastectomy and reconstruction claims for nonmetastatic IBC. Competing risk and Cox regression were used to assess whether IBR was associated with higher breast cancer‐specific mortality (BCSM) or overall mortality (OM). Among 552 936 patients, 1472 (median age 74 years) were diagnosed with IBC and had a mastectomy. Forty‐four patients (3%) underwent IBR. Younger age, a lower Charlson comorbidity score, and a greater median income were predictors of IBR use. Tumor grade, hormone receptor status, and lymph node status were independent predictors of adjusted OM and BCSM. There was no difference by IBR status in BCSM or covariate‐adjusted BCSM (sHR 1.04; CI 0.71‐1.54; P = .83 and sHR 1.13; CI 0.84‐1.93; P = .58, respectively). Cumulative incidence of OM was lower among IR patients (P = .013), and IR did not influence the cumulative incidence of BCSM (P = .91). IBR was not associated with increased overall and BCSM mortality. Although further study of IBR in the IBC setting may be of value, these data suggest that IBC should not be considered an absolute contraindication to IBR.

Breast Reconstruction in Inflammatory Breast Cancer: An Analysis of Predictors, Trends, and Survival from the National Cancer Database

“…Although IBR has been historically discouraged in the setting of IBC on the basis of expert opinion rather than randomized trials, more recent reports suggest acceptable outcomes without decreased survival or increased recurrence rates. 1 , 5 , 16 , 38 , 39 The benefits of skin-sparing mastectomy and IBR are lost when wider skin resections are necessary, as is often the case with IBC. In patients with good response to neoadjuvant chemotherapy, a more limited skin resection may be possible, thereby facilitating improved aesthetic outcomes with IBR.…”

“…Although IBR may be associated with higher perioperative complications compared to delayed reconstruction in the IBC population, previous studies have suggested IBR to be oncologically safe compared to no reconstruction. 1 , 5 Prior studies have suggested that patients experiencing delays of more than 90 days in delivery of chemotherapy had worse OS and cancer-specific survival, and those who experienced a delay in radiotherapy more than 8 weeks had increased locoregional recurrence. 40 , 41 However, there is inconsistent data regarding the impact of IBR on the delivery of adjuvant therapy.…”

“…Previous studies have shown that reconstruction has acceptably low wound complication rates and is not associated with increased recurrence, delay in initiation of adjuvant chemoradiation, or reduced overall or cancer-specific survival. 1 , 5 – 7 Current National Comprehensive Cancer Network guidelines propose that delayed reconstruction with autologous tissue is the preferred option for patients with IBC after modified radical mastectomy and radiation. 8 Moreover, the increased rate of prophylactic contralateral mastectomy at the time of initial surgical treatment for IBC has led to additional consideration of reconstruction options at the time of resection to limit symptomatic chest wall imbalance and improve quality of life.…”

Multi-center investigation of the clinical and pathological characteristics of inflammatory breast cancer based on Chinese Society of Breast Surgery (CSBrs-007)

“…[ 29 ] Many single-center studies have investigated whether breast reconstruction affects oncologic and survival outcomes among patients with IBC. [ 30 – 32 ] Although breast reconstruction is an option for patients with IBC, the time at which reconstructive surgery should be performed remains controversial. One study analyzed SEER data of 3374 patients and noted that rates of contralateral prophylactic mastectomy (CPM) and breast reconstruction have increased over the years.…”

Inflammatory Breast Cancer in a Very Young Genetically Susceptible Woman: Case Presentation in a Tumour Board Session, Discussion and Decision-Making

“…The accepted approach to reconstruction after mastectomy for locally advanced breast cancers and 5 IBC is a delayed one, because of the poor prognosis and concerns about possibility of delays in the main treatments, inadequate margin resection while preserving the skin, and probability of higher recurrence with immediate breast reconstruction 5,6 (IBR). However, surgeries other than MRM and even IBR have been studied for cases of IBC.…”