Partial Breast Reconstruction with Lateral Chest Wall Perforator Flap to Facilitate Breast Conservation in Breast Cancer: First 100 Cases with Cancer Outcomes at 8 Years Follow-Up and the Lessons Learned

Abstract

Pankaj Gupta Roy,1 Laura Mustata,1,2 Jesse Hu,1,3 Ben Phillips,4 Vaishali Parulekar,5 Madhu Bhattacharyya,5 Adrian Harris,6 Sileida Oliveros6 1Department of Breast Surgery, Oxford University Hospitals NHSFT, The Churchill Hospital, Oxford, UK; 2Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania; 3Department of General Surgery, National University Health System, Singapore; 4Department of Breast Pathology, Oxford University Hospitals NHSFT, The Churchill Hospital, Oxford, UK; 5Department of Breast Radiology, Oxford University Hospitals NHSFT, The Churchill Hospital, Oxford, UK; 6Department of Breast Oncology, Oxford University Hospitals NHSFT, The Churchill Hospital, Oxford, UKCorrespondence: Pankaj Gupta RoyDepartment of Breast Surgery, Oxford University Hospitals NHSFT, The Churchill Hospital, Old Road, Oxford, OX3 7LF, UKTel [phone]Email [email protected]: This is a prospective cohort study of partial breast reconstruction (PBR) with a lateral chest wall perforator flap (LCWPF) to facilitate breast conservation surgery (BCS) for women undergoing surgery for breast cancer. The study was undertaken to study the clinical and cancer outcomes.Methods: Patients diagnosed with ductal carcinoma in situ (DCIS) or breast cancer who consented to undergo BCS with PBR with LCWPF were included in the study. A prospective database has been maintained to collect information on clinico-pathological features, complications, and follow-up. Patients were asked to complete an anonymised PROM questionnaire over the years. The hospital electronic records were interrogated for women who have completed 5 years follow-up to assess for development of recurrence/events.Results: A total of 105 patients underwent PBR with LCWPFs between 2011 and 2018. Of these, 74% underwent cancer resection and PBR as one operation whilst 26% underwent PBR as a two-stage approach. The median tumor size on pre-op imaging was 30 mm for the one-stage approach and 39.5 mm for the two-stage approach (p-value=0.003). The complication rates were low and the re-operation rate for close margins was 10%, with 4% eventually requiring mastectomy. Good-to-excellent esthetic outcomes were reported in more than 80% of cases by patients and clinicians. The local recurrence rate (LR) was 2%, distant recurrence rate 10.5%, disease free survival (DFS) 86%, distant disease-free survival (DDFS) 89% and overall survival (OS) 94.8% at 4.5 years median follow-up. This procedure provides an effective oncological approach, avoiding mastectomy with a good-to-excellent cosmetic outcome. The follow-up data establishes the safety of this approach.Discussion: This is the first published series of recurrence and survival data in patients undergoing PBR. We intend to continue with data collection to assess long-term outcomes beyond 10 years. The authors would recommend consideration of this technique to facilitate BCS and avoid mastectomy.Registration: Not applicable.Keywords: lateral chest wall perforator flap, breast conservation surgery, partial breast reconstruction, PBR, PROMs, breast cancer, breast cancer outcomes

Keywords

• lateral chest wall perforator flap breast conservation surgery partial breast reconstruction pbr proms breast cancer breast cancer outcomes