title: Treatment and outcome of patients with chest wall recurrence after mastectomy and breast reconstruction.
abstract: BACKGROUND
  Chest wall recurrence (CWR) in the setting of previous mastectomy and breast reconstruction can pose complex management dilemmas for clinicians. We examined the impact of breast reconstruction on the treatment and outcomes of patients who subsequently developed a CWR.
  
  
  METHODS
  Between 1988 and 1998, 155 breast cancer patients with CWR after mastectomy were evaluated at our center. Of these patients, 27 had previously undergone breast reconstruction (immediate in 20; delayed in 7). Clinicopathologic features, treatment decisions, and outcomes were compared between the patients with and without previous breast reconstruction. Nonparametric statistics were used to analyse the data.
  
  
  RESULTS
  There were no significant differences between the reconstruction and no-reconstruction groups in time to CWR, size of the CWR, number of nodules, ulceration, erythema, and association of CWR with nodal metastases. In patients with previous breast reconstruction, surgical resection of the CWR and repair of the resulting defect tended to be more complex and was more likely to require chest wall reconstruction by the plastic surgery team rather than simple excision or resection with primary closure (26% [7 of 27] versus 8% [10 of 128], P = 0.013). Risk of a second CWR, risk of distant metastases, median overall survival after CWR, and distant-metastasis-free survival after CWR did not differ significantly between patients with and without previous breast reconstruction.
  
  
  CONCLUSIONS
  Breast reconstruction after mastectomy does not influence the clinical presentation or prognosis of women who subsequently develop a CWR. Collaboration with a plastic surgery team may be beneficial in the surgical management of these patients.
authors.affiliation: Department of Surgical Oncology, Box 444, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
authors.forename: Anees
authors.initials: A
authors.lastname: Chagpar
authors.forename: Howard N
authors.initials: HN
authors.lastname: Langstein
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kronowitz
authors.forename: S Eva
authors.initials: SE
authors.lastname: Singletary
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D035441:Thoracic Wall; D013997:Time Factors; D016896:Treatment Outcome