title: Challenging a traditional paradigm: 12-year experience with autologous free flap breast reconstruction for inflammatory breast cancer.
abstract: BACKGROUND
  Inflammatory breast cancer is a rare but aggressive breast cancer with an overall poor prognosis. Traditionally, reconstruction has not been offered, because of poor long-term survival, the need for multimodality treatment, and complex treatment sequencing. The authors examined the safety and feasibility of free flap breast reconstruction for inflammatory breast cancer.
  
  
  METHODS
  A retrospective analysis of all patients who underwent reconstruction for inflammatory breast cancer from January of 2000 to December of 2012 was conducted.
  
  
  RESULTS
  Of 830 inflammatory breast cancer patients, 59 (7.1 percent; median age, 48 years; range, 27 to 65 years) underwent free flap reconstruction. All patients received chemotherapy and radiation therapy. Most patients (n = 52) underwent delayed reconstruction. Five patients with a history of prior partial mastectomy and irradiation developed inflammatory breast cancer and underwent immediate reconstruction following completion mastectomy. Two others underwent immediate chest wall and breast reconstruction following resection. Thirteen patients underwent bilateral reconstruction, and seven required a bipedicled abdominal flap for the unilateral mastectomy defect. Thirty-seven patients (62.7 percent) required revision of the reconstructed breast, and 29 (49.2 percent) had a contralateral balancing procedure to optimize symmetry. Complications occurred in 21 patients (35.6 percent), with one total flap loss (1.7 percent). The median length of follow-up was 43.9 months; 49 patients (83.1 percent) were alive without evidence of recurrent disease.
  
  
  CONCLUSIONS
  Autologous free flap breast reconstruction can be performed safely in inflammatory breast cancer patients, with acceptable complication rates and without an increased risk for flap loss. Inflammatory breast cancer should not preclude free flap breast reconstruction.
  
  
  METHODS
  Therapeutic, IV.
authors: Houston, Texas From the Departments of Plastic and Reconstructive Surgery and Breast Medical Oncology, the Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, and the Department of Surgical Oncology, Breast Surgery, The University of Texas M. D. Anderson Cancer Center.
authors: Edward I
authors: EI
authors: Chang
authors: Eric I
authors: EI
authors: Chang
authors: Ran
authors: R
authors: Ito
authors: Hong
authors: H
authors: Zhang
authors: Alexander T
authors: AT
authors: Nguyen
authors: Roman J
authors: RJ
authors: Skoracki
authors: Matthew M
authors: MM
authors: Hanasono
authors: Melissa A
authors: MA
authors: Crosby
authors: Naoto T
authors: NT
authors: Ueno
authors: Kelly K
authors: KK
authors: Hunt
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000706:statistics & numerical data; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D016462:Mammaplasty / Q000379:methods* / Q000706:statistics & numerical data; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D035441:Thoracic Wall / Q000601:surgery
references: Dawood S, Ueno NT, Valero V, et al. Differences in survival among women with stage III inflammatory and noninflammatory locally advanced breast cancer appear early: A large population-based study. Cancer. 2011;117:1819–1826
references: Schairer C, Brown LM, Mai PL. Inflammatory breast cancer: High risk of contralateral breast cancer compared to comparably staged non-inflammatory breast cancer. Breast Cancer Res Treat. 2011;129:117–124
references: Dawood S, Ueno NT, Valero V, et al. Identifying factors that impact survival among women with inflammatory breast cancer. Ann Oncol. 2012;23:870–875
references: Singletary SE. Surgical management of inflammatory breast cancer. Semin Oncol. 2008;35:72–77
references: Dawood S, Merajver SD, Viens P, et al. International expert panel on inflammatory breast cancer: Consensus statement for standardized diagnosis and treatment. Ann Oncol. 2011;22:515–523
references: Yamauchi H, Woodward WA, Valero V, et al. Inflammatory breast cancer: What we know and what we need to learn. Oncologist. 2012;17:891–899
references: Hoffman HJ, Khan A, Ajmera KM, Zolfaghari L, Schenfeld JR, Levine PH. Initial response to chemotherapy, not delay in diagnosis, predicts overall survival in inflammatory breast cancer cases. Am J Clin Oncol. 2012;37:315–321
references: Bates T, Williams NJ, Bendall S, Bassett EE, Coltart RS. Primary chemo-radiotherapy in the treatment of locally advanced and inflammatory breast cancer. Breast. 2012;21:330–335
references: Baumann DP, Crosby MA, Selber JC, et al. Optimal timing of delayed free lower abdominal flap breast reconstruction after postmastectomy radiation therapy. Plast Reconstr Surg. 2011;127:1100–1106
references: Chang EI, Chang EI, Soto-Miranda MA, et al. Comprehensive analysis of donor-site morbidity in abdominally based free flap breast reconstruction. Plast Reconstr Surg. 2013;132:1383–1391
references: Garvey PB, Clemens MW, Hoy AE, et al. Muscle-sparing TRAM flap does not protect breast reconstruction from postmastectomy radiation damage compared with the DIEP flap. Plast Reconstr Surg. 2014;133:223–233
references: Tran NV, Evans GR, Kroll SS, et al. Postoperative adjuvant irradiation: Effects on transverse rectus abdominis muscle flap breast reconstruction. Plast Reconstr Surg. 2000;106:313–317
references: Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg. 2013;132:1305–1314
references: Saaristo AM, Niemi TS, Viitanen TP, Tervala TV, Hartiala P, Suominen EA. Microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients. Ann Surg. 2012;255:468–473
references: Cheng MH, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: Flap anatomy, recipient sites, and outcomes. Plast Reconstr Surg. 2013;131:1286–1298
references: Althubaiti GA, Crosby MA, Chang DW. Vascularized supraclavicular lymph node transfer for lower extremity lymphedema treatment. Plast Reconstr Surg. 2013;131:133e–135e
references: Beahm EK, Chang DW. Chest wall reconstruction and advanced disease. Semin Plast Surg. 2004;18:117–129
references: Behnam AB, Nguyen D, Moran SL, Serletti JM. TRAM flap breast reconstruction for patients with advanced breast disease. Ann Plast Surg. 2003;50:567–571
references: Sultan MR, Smith ML, Estabrook A, Schnabel F, Singh D. Immediate breast reconstruction in patients with locally advanced disease. Ann Plast Surg. 1997;38:345–349
references: Untch M, Fasching PA, Konecny GE, et al. Pathologic complete response after neoadjuvant chemotherapy plus trastuzumab predicts favorable survival in human epidermal growth factor receptor 2-overexpressing breast cancer: Results from the TECHNO trial of the AGO and GBG study groups. J Clin Oncol. 2011;29:3351–3357
references: Semiglazov V, Eiermann W, Zambetti M, et al. Surgery following neoadjuvant therapy in patients with HER2-positive locally advanced or inflammatory breast cancer participating in the NeOAdjuvant Herceptin (NOAH) study. Eur J Surg Oncol. 2011;37:856–863