title: Immediate Reconstruction in Inflammatory Breast Cancer: Challenging Current Care.
abstract: Inflammatory breast cancer (IBC) is an aggressive disease that is treated with trimodality therapy consisting of neoadjuvant chemotherapy, surgery, and post-mastectomy radiation therapy (PMRT). Traditionally, modified radical mastectomy without reconstruction has been the operation of choice for patients with IBC due to fears of high rates of margin positivity, risk of local recurrence, and the need for PMRT.
  
  
  
  A retrospective review was performed to evaluate women with IBC at our institution from 2006 to 2014 who completed trimodality therapy. Patients were identified as undergoing reconstruction or no reconstruction (NR), with reconstruction being further classified as immediate (IR) if reconstruction occurred at the initial surgery, or delayed (DR) if initial reconstruction occurred after PMRT.
  
  
  
  Sixty women with IBC were identified using inclusion criteria. The median follow-up was 2.3 years (range 1.4-4.6). Patients with IR had a statistically significant increased risk (p = 0.006) in postoperative complication rates compared with DR (0 %) and NR (2.6 %). Two patients had positive skin margins on final pathology (one IR, one NR), with both eventually having recurrence. Time to PMRT was delayed 10 days in patients with IR compared with those without IR. No statistically significant difference in recurrence rates was observed (p = 0.86) when comparing patients with IR and those with NR, and no difference in survival was observed between patients who had reconstruction and those without (p = 0.91).
  
  
  
  Performing IR with mastectomy for IBC is associated with increased complications, but is not associated with decreased survival or increased recurrence in selected patients. IR in selected IBC patients can facilitate successful breast reconstruction.
authors.affiliation: Department of General Surgery, Division of Breast Services, Cleveland Clinic Foundation, Cleveland, OH, USA. simpsoa@ccf.org.
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Simpson
authors.affiliation: Department of General Surgery, Division of Breast Services, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Devina
authors.initials: D
authors.lastname: McCray
authors.affiliation: Department of General Surgery, Division of Breast Services, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Wengler
authors.affiliation: Department of General Surgery, Division of Breast Services, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Crowe
authors.affiliation: Department of Plastic of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Risal
authors.initials: R
authors.lastname: Djohan
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Tendulkar
authors.affiliation: Quantitative Health Services, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: O'Rourke
authors.affiliation: Department of General Surgery, Division of Breast Services, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.affiliation: Department of General Surgery, Division of Breast Services, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Valente
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005500:Follow-Up Studies; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000628:therapy*; D016462:Mammaplasty / Q000009:adverse effects; D000072662:Margins of Excision; D015411:Mastectomy, Modified Radical / Q000009:adverse effects; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors