title: Local recurrence following mastectomy and autologous breast reconstruction: incidence, risk factors, and management.
abstract: BACKGROUND
  Breast reconstruction (BR), including autologous breast reconstruction (ABR) after mastectomy (MST), has been gaining popularity all around the world, especially in the People's Republic of China during the past decade. However, there is a small proportion, but a significant number, of patients who develop local recurrence (LR) of breast cancer postoperatively. The purpose of this study is to examine the incidence of LR, discuss risk factors associated with LR, and management of LR following MST and ABR.
  
  
  METHODS
  A total of 397 patients who underwent MST and ABR after diagnosis of breast cancer were included in this retrospective study. Data were analyzed by the Kaplan-Meier method, the log-rank statistical test, and Cox proportional hazards model.
  
  
  RESULTS
  From January 1999 to December 2011, 400 ABRs were performed in 397 patients in Fudan University Shanghai Cancer Center. The median follow-up time in the study was 3.6 years. LR occurred in 11 of 397 patients, with a median time to LR of 2.9 years. In univariate and multivariate analyses, tumor stage, hormonal therapy (yes or no), and tumor type (multifocal or nonmultifocal) were significantly associated with LR after ABR following MST.
  
  
  CONCLUSIONS
  ABR is an oncologically safe surgical procedure with an acceptable LR rate of 2.8%. Risk factors associated with high rate of LR were higher tumor stage, absence of hormonal therapy, and multifocal tumor type.
authors.affiliation: Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University.
authors.forename: Siyu
authors.initials: S
authors.lastname: Wu
authors.affiliation: Clinical Statistics Center, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.
authors.forename: Miao
authors.initials: M
authors.lastname: Mo
authors.affiliation: Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University.
authors.forename: Yujie
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University.
authors.forename: Na
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University.
authors.forename: Genhong
authors.initials: G
authors.lastname: Di
authors.affiliation: Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University.
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Shao
authors.affiliation: Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University.
authors.forename: Jiong
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University.
authors.forename: Guangyu
authors.initials: G
authors.lastname: Liu
keywords: autologous breast reconstruction; incidence; local recurrence; management; risk factors