title: Locally Advanced Breast Cancer: Autologous Versus Implant-based Reconstruction.
abstract: Recent papers and guidelines agree that patients with locally advanced breast cancer (LABC) should be offered breast reconstruction. Yet, the type of reconstruction in this group of patients is still a point of controversy.
  
  
  METHODS
  One hundred fourteen patients, treated for LABC from 2007 to 2013, were divided into 3 groups based on the reconstructive option: no reconstruction (NR), implant-based/expander-based reconstruction (IBR), and autologous tissue reconstruction (ATR). We analyzed demographics and compared delay in adjuvant therapy, length of hospitalization, surgical complications, failure of reconstruction, local recurrence, and disease-free survival.
  
  
  RESULTS
  Twenty-six patients had NR, 38 had IBR, and 50 had ATR. No significant difference was found in the percentage of patients who had their adjuvant treatment delayed [16% (NR) vs 22% (IBR) vs 14% (ATR)]. Mean length of hospitalization for the NR, IBR, and ATR groups was 2.7, 6, and 7.5 days, respectively. Complication rates requiring readmission were 36% (NR), 42% (IBR), and 32% (ATR). In the IBR group, 37% of implants were removed because of complications. Failure of reconstruction was 37% and 0% for the IBR and ATR groups, respectively. Local recurrence rates in the NR and Reconstruction (groups IBR and ATR combined) groups were 7% and 2%, respectively. Mean survival times in patients were 18 (NR), 10.3 (IBR), and 12.2 (ATR) months.
  
  
  CONCLUSIONS
  No significant difference was found in the hospital stay length, adjuvant treatment delay, and complication rates between IBR and ATR. High rates of failed reconstruction suggest that the use of implants should be considered very carefully in patients with LABC.
authors.affiliation: Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; University of Manchester, Manchester, United Kingdom; and Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Tanos
authors.affiliation: Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; University of Manchester, Manchester, United Kingdom; and Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Elena
authors.initials: E
authors.lastname: Prousskaia
authors.affiliation: Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; University of Manchester, Manchester, United Kingdom; and Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Whitney
authors.initials: W
authors.lastname: Chow
authors.affiliation: Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; University of Manchester, Manchester, United Kingdom; and Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Angelaki
authors.affiliation: Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; University of Manchester, Manchester, United Kingdom; and Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Cleona
authors.initials: C
authors.lastname: Cirwan
authors.affiliation: Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; University of Manchester, Manchester, United Kingdom; and Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Hisham
authors.initials: H
authors.lastname: Hamed
authors.affiliation: Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; University of Manchester, Manchester, United Kingdom; and Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Jian
authors.initials: J
authors.lastname: Farhadi