Risk factors of local recurrence following implant-based breast reconstruction in breast cancer patients

Abstract

Background The number of patients desiring implant-based breast reconstruction has been increasing. While local recurrence is observed in patients with breast reconstruction, only a few reports have focused on the risk factors for local recurrence and the prognosis after developing local recurrence. Methods We analyzed 387 patients who underwent implant-based breast reconstruction during the period from 2004 to 2017 in Hiroshima City Hospital. We retrospectively examined the risk factors for local recurrence and the outcomes of patients developing such recurrence after implant-based breast reconstruction. Results The median follow-up time was 59 months. The local recurrence rate was 3.1% (n = 12). The most common reason for detecting local recurrence was a palpable mass. Four patients with local recurrence had recurrence involving the skin just above the primary lesion and needle biopsy tract. All patients with local recurrence received surgery and systemic therapy and most patients received radiation therapy, all have remained free of new recurrence to date. Multivariate analysis showed lymphatic vessel invasion (HR, 6.63; 95% CI, 1.40–31.36; p = 0.017) and positive or < 2 mm vertical margin (HR, 9.72; 95%CI, 1.23–77.13; p = 0.047) to be associated with significantly increased risk of local recurrence. Conclusions The risk factors for local recurrence following implant-based breast reconstruction were lymphatic vessel invasion and positive or < 2 mm vertical margin. Removal of the skin just above the primary lesion and needle biopsy tract and adjuvant radiation therapy might improve local outcomes. Patients with local recurrence following implant-based breast reconstruction appear to have good outcomes with appropriate treatment.

Novel nomograms for predicting survival for immediate breast reconstruction patients diagnosed with invasive breast cancer—a single-center 15-year experience

“…In immediate implant-based ( 19 ) and autologous ( 20 ) breast reconstruction studies, LVI, tumor staging, multifocality, and absence of hormonal therapy were risk factors associated with local regional recurrence. The novel nomogram further confirmed that younger age, comorbidities, advanced tumor staging, bilateral malignancy, and higher number of positive lymph nodes were associated with worse DFS.…”

Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction: A Systemic Review and Meta-analysis

“…Several studies have demonstrated the potential benefits of implant-based breast reconstruction and oncological outcomes. Fujihara et al 41 showed that the local recurrence rate after implant-based breast reconstruction was 3.1%. In our analysis, the recurrence rates for breasts undergoing prepectoral IBBR were 2.77% (14/504) and subpectoral IBBR was 1.91% (7/366).…”

Breast Cancer Local Recurrence in Patients with and without Post-Mastectomy Immediate Breast Reconstruction: Systematic Review & Meta-Analysis Protocol

“…Patient related factors include elevated body mass index, advanced age, and young age. 15,16 Rough textured implants have raised concerns about both implant related anaplastic large cell lymphoma's as well as local primary recurrence. 17 Leaving the skin immediately overlying the initial tumor and the needle track site of a core needle biopsy have been implicated in LR.…”

“…17 Leaving the skin immediately overlying the initial tumor and the needle track site of a core needle biopsy have been implicated in LR. 18 Furthermore, radiation increases risk of complications, including infection, skin necrosis, and loss of reconstruction for both autologous and prosthetic. 5 Therefore, those receiving radiation, may see stronger bene ts when delayed reconstruction is performed.…”

“…5 Tumor related factors such as human epidermal growth factor receptor 2 (HER-2) positive, triple negative, estrogen receptor (ER) and progesterone receptor (PR) negative, size of tumour, tumour grade, tumour located on inner quadrant, lymphovascular invasion close/ positive margins and more advanced disease are known to increase recurrence risks. 15,[19][20][21] The lack of clear conclusions in the literature regarding IBR complicates clinical decision-making and patient education. Conducting a systematic review and meta-analysis may provide valuable insights into this extensively debated issue.…”