title: Immediate transverse rectus abdominis musculocutaneous flap reconstruction is associated with improved cancer-specific survival in locally advanced breast cancer.
abstract: BACKGROUND
  This study of stage III (locally advanced) breast cancer patients evaluated the survival improvement conferred by immediate breast reconstruction by transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction after modified radical mastectomy (MRM) in comparison with MRM alone.
  
  
  METHODS
  This retrospective study analyzed data for all women who had received TRAM immediately after unilateral modified radical mastectomy for locally advanced breast cancer at a single institution from January 2002 to December 2009. The analysis included 192 patients divided into 2 groups: patients who had received MRM immediately followed by TRAM flap reconstruction (MRM-TRAM group, n=52) and patients who had received MRM alone (MRM group, n=140). Data collection included demographic characteristics, underlying comorbidities, and cancer characteristics. Postoperative adjuvant therapies, oncologic outcomes, and survival were compared between the 2 groups. Kaplan-Meier plots, univariate log-rank test, multivariate Cox proportional hazards regression models, and t-test were used to evaluate potential predictors of cancer recurrence and patient survival.
  
  
  RESULTS
  In comparison with the MRM group, significant differences in the MRM-TRAM group included a younger mean age, a better overall health status, and a higher education level (all P<0.001). Severity of breast cancer disease did not significantly differ in terms of cancer characteristics. Additionally, there were no significant differences in local recurrence (P=0.326) and distant metastasis (P=0.338). Immediate breast reconstruction was not associated with delays in detection of local recurrence and initiation of adjuvant therapiesThe 5-year breast cancer-specific survival rate was significantly higher in the MRM-TRAM group (84.6%) compared with the MRM group (61.2%) (P=0.003). Multivariate analysis showed that TRAM flap reconstruction is an independent predictor of survival in breast cancer patients. The MRM-TRAM group had a significantly lower hazard of death (HR, 0.235; 95% CI, 0.070-0.788; P=0.019) compared with the MRM group.
  
  
  CONCLUSIONS
  Immediate TRAM flap reconstruction is oncologically safe and is unassociated with delayed adjuvant therapies or delayed detection of local recurrence. Patients with locally advanced breast cancer can be considered appropriate candidates for TRAM flap reconstruction because the procedure is an independent predictor of breast cancer survival and is associated with a 76.5% decrease (HR, 0.235) in the risk of cancer death.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, and †General Surgery Medicine, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China.
authors.forename: Tung-Ying
authors.initials: TY
authors.lastname: Hsieh
authors.forename: Yun-Nan
authors.initials: YN
authors.lastname: Lin
authors.forename: Sin-Daw
authors.initials: SD
authors.lastname: Lin
authors.forename: Chung-Sheng
authors.initials: CS
authors.lastname: Lai
authors.forename: Kao-Ping
authors.initials: KP
authors.lastname: Chang
authors.forename: Su-Shin
authors.initials: SS
authors.lastname: Lee
authors.forename: Shu-Hung
authors.initials: SH
authors.lastname: Huang
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Hou
authors.forename: Fang-Ming
authors.initials: FM
authors.lastname: Chen
authors.forename: Fu
authors.initials: F
authors.lastname: Ou-Yang
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D064827:Myocutaneous Flap; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D017568:Rectus Abdominis / Q000637:transplantation*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors