title: Immediate reconstruction following breast-conserving surgery: management of the positive surgical margins and influence on secondary reconstruction.
abstract: The efficacy of breast-conserving surgery for the local control of early breast cancer has been repeatedly evidenced. Although immediate reconstruction following breast-conserving surgery has been described, little information is available regarding surgical management in reoperative settings due to positive margins. We studied the influence of intraoperatively assessed and postoperatively controlled surgical margin status on the type of breast-conserving surgery and report our results regarding complications in a reoperative breast reconstruction scenario. All patients were seen by a multidisciplinary team who recommended breast-conserving surgery. According to the breast volume, ptosis and tumor size/location, the patients were also evaluated by a plastic surgeon, who recommended reconstruction with the appropriate technique. Intraoperative assessment of surgical margins was determined by histological examination of frozen sections. The mean follow-up time was 48 months. Two hundred and eighteen patients (88.5%) underwent breast-conserving surgery and immediate reconstruction. Twelve (5.5%) patients had a positive tumor margin after review of the permanent section. All patients underwent re-exploration. In 1.3%, a second reconstructive technique was indicated and in 2.2% a skin-sparing mastectomy with total reconstruction was performed. Our findings support the important role of the intraoperative assessment of surgical margins and its interference in the selection of reconstruction techniques and negative margins; however, it will not guarantee complete excision of the tumor. Success depends on coordinated planning with the oncologic surgeon and careful intraoperative management.
authors.affiliation: Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil. munhozalex@uol.com.br
authors.forename: Alexandre Mendonça
authors.initials: AM
authors.lastname: Munhoz
authors.forename: Eduardo
authors.initials: E
authors.lastname: Montag
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arruda
authors.forename: Cláudia Maria
authors.initials: CM
authors.lastname: Aldrighi
authors.forename: José R
authors.initials: JR
authors.lastname: Filassi
authors.forename: José R
authors.initials: JR
authors.lastname: Piato
authors.forename: Luis C
authors.initials: LC
authors.lastname: Prado
authors.forename: José Mendes
authors.initials: JM
authors.lastname: Aldrighi
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
authors.forename: Marcus C
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005629:Frozen Sections; D006801:Humans; D016462:Mammaplasty; D015412:Mastectomy, Segmental; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies