title: Anterior chest wall resection and reconstruction for locally advanced breast cancer.
abstract: With breast cancer awareness, the incidence of large invasive tumours is rare. We present a video of locally advanced breast cancer invading the anterior chest wall requiring en bloc resection that resulted in a large chest wall defect with exposed pleural and pericardial surface. Skeletal reconstruction and provision of adequate soft tissue coverage in order to avoid respiratory failure was challenging. A 58-year-old female presented with a 3-year history of locally invasive breast carcinoma with contiguous spread to sternum, clavicles, sternoclavicular joints and bilateral second to fifth ribs. She underwent total sternectomy, bilateral second to fifth ribs and chest wall resection resulting in a 21 × 18 cm chest wall defect. Reconstruction of her sternum was with methyl-methacrylate cement prosthesis. Ribs were reconstructed with titanium plates. Soft tissue coverage was achieved with left vertical rectus abdominis pedicle flap, right external oblique transposition flap and a right latissimus dorsi free flap. Flap failure necessitated a right vastus lateralis free flap. She was discharged ambulant without respiratory compromise. Resection and reconstruction of large chest wall defects is possible due to new bioprosthetic materials and is possible with acceptable morbidity and mortality.
authors.affiliation: Department of Thoracic Surgery, Tan Tock Seng Hospital, Singapore hide.wee@mohh.com.sg.
authors.forename: Hide Elfrida
authors.initials: HE
authors.lastname: Wee
authors.affiliation: Department of Thoracic Surgery, Tan Tock Seng Hospital, Singapore.
authors.forename: Fazuludeen Ali
authors.initials: FA
authors.lastname: Akbar
authors.affiliation: Department of Thoracic Surgery, Tan Tock Seng Hospital, Singapore.
authors.forename: Keerthi
authors.initials: K
authors.lastname: Rajapaksha
authors.affiliation: Department of Thoracic Surgery, Tan Tock Seng Hospital, Singapore.
authors.forename: Dokev Basheer Ahmed
authors.initials: DB
authors.lastname: Aneez
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D019651:Plastic Surgery Procedures / Q000379:methods*; D012272:Ribs / Q000601:surgery; D013249:Sternum / Q000601:surgery; D035441:Thoracic Wall / Q000473:pathology / Q000601:surgery*
keywords: Breast cancer; Chest wall resection; Free flap; Reconstruction defects; Sternal reconstruction; Tumour reconstruction