Outpatient management of locally advanced breast cancer using immediate local thoraco-abdominal advancement flap
Artur Fahradyan, MD,1 Alice Liu, BA,2, Lesley Taylor,MD,3 Veronica Jones, MD,3, Wai-Yee Li, MD, PhD4 1. Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA 2. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA 3. Division of Breast Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA 4. Division of Plastic and Reconstructive Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
Background: Patients with locally advanced invasive breast cancer (LABC) are often considered inoperable, due to the anticipated chest wall defect and need for complex reconstruction. We present a series of patients who underwent mastectomy with extensive skin resection and immediate chest wall reconstruction using a local thoraco-abdominal advancement flap (TAAF).
Methods: This is a single-surgeon, single-institution retrospective chart review of patients with LABC who underwent mastectomy with skin resection and local TAAF from May 2017 to October 2019, with minimum 3 months follow up.
Results: Thirteen patients met inclusion criteria. 12 of 13 patients presented with stage III or IV invasive breast cancer, with skin involvement. The mean chest wall defect measured 248.7cm2 (140 – 336, SD 63.2) and all were successfully reconstructed with immediate local TAAF. There were no intraoperative complications but one patient developed a post op. The mean hospital stay was 1.3 nights, with nine (69.2%) patients staying <23 hours and 4 (30.8%) patients staying two nights. 9 (69.2%) patients underwent adjuvant therapy, beginning on average 32 days (13 – 55, SD 13.1) after surgery. The mean follow-up time was 13.8 months (4.5– 31.6, SD 9.2).
Conclusion: Our study demonstrates that reconstruction with local TAAF is an outpatient procedure that reliably provides durable, immediate chest wall coverage, after mastectomy in patients with LABC. Unlike complex reconstruction, this technique has a short operative time, low blood loss and low complication rate, allowing timely adjuvant therapy. We also present survival outcomes data on these surgically managed patients.
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