title: Immediate breast reconstruction with expander in pregnant breast cancer patients.
abstract: BACKGROUND
  Breast reconstruction after mastectomy is currently considered an essential component in managing breast cancer patients, particularly those diagnosed at a young age. However, no studies have been published on the feasibility of immediate breast reconstruction in patients diagnosed and operated during the course of gestation.
  
  
  METHODS
  We retrospectively identified all breast cancer patients who were subjected to mastectomy and immediate breast reconstruction during pregnancy at the European Institute of Oncology between 2002 and 2012. Patient demographics, gestational age at surgery, tumor stage, adjuvant treatment, details of the surgical procedures, surgical outcomes and fetal outcomes were analyzed.
  
  
  RESULTS
  A total of 78 patients with breast cancer diagnosed during pregnancy were subjected to a surgical procedure during the course of gestation. Twenty-two patients had mastectomy; of whom 13 were subjected to immediate breast reconstruction. Twelve out of 13 patients had a two-stage procedure with tissue expander insertion. Median gestational age at surgery was 16 weeks. No major surgical complications were encountered. Only one patient elected to have an abortion, otherwise, no spontaneous abortions or pregnancy complications were reported. Median gestational age at delivery was 35 weeks (range: 32-40 weeks). No major congenital malformations were reported. At a median follow-up of 32 months, all patients are alive with no long-term surgical complications.
  
  
  CONCLUSIONS
  This is the first study of immediate breast reconstruction in pregnant breast cancer patients. Tissue expander insertion appears to ensure a short operative time, and does not seem to be associated with considerable morbidity to the patient or the fetus. Hence, it could be considered in the multidisciplinary management of women diagnosed with breast cancer during pregnancy.
authors.affiliation: Division of Plastic Surgery, European Institute of Oncology, Via Ripamonti, 435 - 20141 Milano, Italy; Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand. Electronic address: lohsiriwat@gmail.com.
authors.forename: Visnu
authors.initials: V
authors.lastname: Lohsiriwat
authors.forename: Fedro Alessandro
authors.initials: FA
authors.lastname: Peccatori
authors.forename: Stefano
authors.initials: S
authors.lastname: Martella
authors.forename: Hatem A
authors.initials: HA
authors.lastname: Azim
authors.forename: Maria Anna
authors.initials: MA
authors.lastname: Sarno
authors.forename: Viviana
authors.initials: V
authors.lastname: Galimberti
authors.forename: Francesca
authors.initials: F
authors.lastname: De Lorenzi
authors.forename: Mattia
authors.initials: M
authors.lastname: Intra
authors.forename: Claudia
authors.initials: C
authors.lastname: Sangalli
authors.forename: Nicole
authors.initials: N
authors.lastname: Rotmensz
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Pruneri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Renne
authors.forename: Mario Casales
authors.initials: MC
authors.lastname: Schorr
authors.forename: Luiz Felipe
authors.initials: LF
authors.lastname: Nevola Teixeira
authors.forename: Mario
authors.initials: M
authors.lastname: Rietjens
authors.forename: Massimo
authors.initials: M
authors.lastname: Giroda
authors.forename: Oreste
authors.initials: O
authors.lastname: Gentilini
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D050498:Live Birth; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods*; D008408:Mastectomy; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D015625:Tissue Expansion Devices
keywords: Breast cancer; Immediate reconstruction; Mastectomy; Pregnancy