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Wu ZY, Han HH, Han J, Kim HJ, Lee J, Chung IY, Kim J, Lee S, Eom JS, Kim SB, Gong G, Kim HH, Son BH, Ahn SH, Ko B. Impact of Local Breast Cancer Recurrence on Reconstructed Breast in Nipple-Sparing Mastectomy with Immediate Reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:2535-2541. [PMID: 35487872 DOI: 10.1016/j.bjps.2021.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/31/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
The impact of locally recurrent breast cancer on reconstructed breasts remains largely unknown. Therefore, this study aimed to investigate the incidence of reconstruction loss due to local recurrence in patients who underwent nipple-sparing mastectomy with immediate reconstruction for breast cancer and to identify potential recurrence-associated risk factors for loss of index reconstruction. The records of 1,696 patients who underwent nipple-sparing mastectomy with immediate reconstruction between March 2003 and December 2016 at a single institution were reviewed. Among them, 128 patients with local breast cancer recurrence as the first event were analyzed. The primary outcome was loss of reconstruction due to local breast cancer recurrence. Reconstruction loss was classified as partial flap loss with breast distortion, complete flap loss, or implant loss during salvage treatment of local recurrence. Reconstruction loss occurred in 21 of the 128 patients (16%). Reconstruction loss rates were 20% for autologous and 9.5% for implant-based reconstruction (P = 0.204). Multivariate analysis showed that recurrent tumor size > 2.0 cm and multifocal recurrence were independent factors associated with an increased risk of reconstruction loss. Moreover, age ≥ 50 years at the time of recurrence diagnosis, recurrent tumor size > 2.0 cm, and multifocal recurrence were independently associated with complete flap/implant loss in the multivariate analysis. The incidence of reconstruction loss due to local breast cancer recurrence after nipple-sparing mastectomy with immediate reconstruction was low in this study. Age ≥ 50 years at recurrence diagnosis and the extent of local recurrence independently affected reconstruction loss. To detect recurrence early, careful follow-up through regular ultrasonography or magnetic resonance imaging at the reconstruction site is important.
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Affiliation(s)
- Zhen-Yu Wu
- Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China; Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun Ho Han
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jing Han
- Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jongwon Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Saebyeol Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hak Hee Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung-Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sei-Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - BeomSeok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Zhu A, Yun Z, You M, Liu X, Liang X, Yan Y, Shao B, Jiang H, Di L, Song G, Li H. Surgical reduction in chest wall disease to prolong survival in breast cancer patients: a retrospective study. Gland Surg 2022; 11:1015-1025. [PMID: 35800744 PMCID: PMC9253183 DOI: 10.21037/gs-22-246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/01/2022] [Indexed: 01/10/2024]
Abstract
BACKGROUND Patients with breast cancer (BC) may develop locoregional recurrence alone or with distant metastases. Results of previous studies discussing the benefit of local surgery among patients with chest wall disease were controversial. Whether surgical reduction for chest wall disease could influence survival outcome is still a question. The objective of this study was to compare overall survival (OS) in patients with recurrence involving the chest wall who did or did not undergo surgical reduction after previous treatment of the primary BC to explore the role of surgical reduction. METHODS We retrospectively reviewed BC patients with chest wall as the first recurrent/metastatic site selected between January 2012 and December 2018 to explore whether surgical reduction for chest wall disease could influence OS. Clinicopathological data, including age at initial diagnosis, TNM stage, the pathological parameters, and treatment were recorded and analyzed. OS was primarily described using the Kaplan-Meier estimator for each group, with the statistical significance between groups being tested by the log-rank test. RESULTS A total of 198 patients with a median age of 48 years (range, 22-73 years) were analyzed. Chest wall as the only site of recurrence occurred in 139 patients (70.2%), and the other 59 (29.8%) patients had other metastatic sites. There were 88 patients who underwent surgical reduction for chest wall recurrence. The median OS was significantly longer for the patients who had chest wall disease reduction than for those who did not {194.2 months [95% confidence interval (CI): 140.4-247.9 months] vs. 102.7 months (95% CI: 79.7-125.7 months), respectively, P=0.001}. From multivariate analysis, surgical reduction was an independent factor significantly influenced OS (HR =0.52, 95% CI: 0.33-0.81, P=0.004). Subgroup analyses showed that OS was statistically longer in the chest wall disease surgical reduction group than in the no reduction group with respect to hormone receptor (HR) negative (-), human epidermal growth factor receptor 2 (HER2) negative (-), triple-negative breast cancer (TNBC), disease-free survival (DFS) >24 months, and chest wall disease only. CONCLUSIONS BC patients with chest wall recurrence could benefit from surgical reduction with a prolonged OS. In a certain selected group, surgical reduction may be warranted.
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Affiliation(s)
- Anjie Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zehui Yun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Miaoning You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoran Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xu Liang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ying Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bin Shao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hanfang Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lijun Di
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Guohong Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
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Chest Wall Resection for Recurrent Breast Cancer in the Modern Era: A Systematic Review and Meta-analysis. Ann Surg 2019; 267:646-655. [PMID: 28654540 DOI: 10.1097/sla.0000000000002310] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To review the literature on chest wall resection for recurrent breast cancer and evaluate overall survival (OS) and quality-of-life (QOL) outcomes. BACKGROUND Full-thickness chest wall resection for recurrent breast cancer is controversial, as historically these recurrences have been thought of as a harbinger of systemic disease. METHODS A systematic search in MEDLINE, EMBASE, and Cochrane CENTRAL identified 48 eligible studies, all retrospective, accounting for 1305 patients. The review is reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary end points were patient-centered QOL outcomes and OS; secondary outcomes included disease-free survival (DFS) and 30-day morbidity. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies instrument and the Oxford Centre for Evidence-Based Medicine's levels of evidence tool. Random-effects meta-analysis was used to create pooled estimates. Meta-regressions and sensitivity analyses were used to explore study heterogeneity by age, year of publication, risk of bias, and surgical intent (curative vs palliative). RESULTS Studies consistently reported excellent OS and DFS in properly selected patients. Pooled estimates for 5-year OS in all studies and those from the past 15 years were 40.8% [95% confidence interval (CI) 35.2-46.7) and 43.1% (95% CI 35.8-50.7), whereas pooled 5-year DFS was 27.1% (95% CI 16.6-41.0). Eight studies reported excellent outcomes related to QOL. Mortality was consistently low (<1%) and 30-day pooled morbidity was 20.2% (95% CI 15.3%-26.3%). Study quality varied, and risk of selection bias in included studies was high. CONCLUSIONS Full-thickness chest wall resection can be performed with excellent survival and low morbidity. Few studies report on QOL; prospective studies should focus on patient-centered outcomes in this population.
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Does Prosthesis-Based Breast Reconstruction Affect the Clinical Outcome of Postmastectomy Radiotherapy? Ann Plast Surg 2018; 80:S7-S10. [DOI: 10.1097/sap.0000000000001286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee S, Jung Y, Bae Y. Immediate chest wall reconstruction using an external oblique myocutaneous flap for large skin defects after mastectomy in advanced or recurrent breast cancer patients: A single center experience. J Surg Oncol 2017; 117:124-129. [PMID: 29082566 DOI: 10.1002/jso.24830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/04/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES We report 75 single-stage chest-wall reconstructions using ipsilateral external oblique myocutaneous flap (EOMCF) to cover the extensive skin defects following resection of advanced or recurrent breast tumours at the Pusan National University Hospital. METHODS Between January 2007 and October 2015, 75 women with advanced or recurred breast cancer who underwent extensive mastectomy with immediate chest wall reconstruction using EOMCF were reviewed retrospectively. RESULTS Mean age was 50.5 ± 9.8 years and mean follow-up period was 36.7 ± 25.1 months. A total of 59 patients (78.7%) had stage III disease and the remaining 16 patients (21.3%) had stage IV. Mean excised breast tissue weight was 687.6 ± 416.5 g (range, 120.3-2797.1 g). The mean chest wall skin defect covered with an EOMCF was 228.3 ± 168.1 cm2 and corresponded to an approximately 15 × 15 cm defect. Average operative time for reconstruction was <2 h. There were no major complications such as flap loss, full thickness skin necrosis, or surgical site infections. With respect to loco-regional recurrence, nine patients (12%) experienced recurrence. Among the 59 non-stage IV patients, loco-regional relapse occurred in five patients (8.5%). CONCLUSIONS EOMCF can effectively cover large chest wall defects with a few minor complications and reliable local disease control.
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Affiliation(s)
- Seokwon Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Younglae Jung
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Youngtae Bae
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Farras Roca JA, Dao TH, Lantieri L, Lepage C, Bosc R, Meyblum E, Pigneur F, Beaussart P, Assaf E, Totobenazara JL, Calitchi E, Belkacemi Y, Rahmouni A, Luciani A. Ipsilateral breast cancer recurrence after Deep Inferior Epigastric Perforator (DIEP) flap reconstruction: Incidence and radiological presentation. Diagn Interv Imaging 2015; 97:203-9. [PMID: 26282051 DOI: 10.1016/j.diii.2015.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/16/2015] [Accepted: 06/19/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the incidence and presentation of ipsilateral cancer recurrences (ICR) after deep inferior epigastric perforator (DIEP) flap reconstruction for breast cancer. PATIENTS AND METHODS Data of 247 consecutive women with DIEP flap reconstruction after breast cancer in our institution between 1997 and 2009 were retrospectively reviewed. RESULTS Mean follow-up time was 4.1years±3.2 (SD) (median: 3years; range: 1month - 14years). Thirty-one patients (12.5%, 95%CI: =8.7-17.3) presented 34 relapses, in average 4.1years±2.6 after mastectomy: 14 (41%) were ipsilateral, 6 (18%) contralateral and 14 (41%) metastatic. ICRs occurred earlier (3.9 vs. 5.8years; P<0.05) than non-ICRs. Most ICRs (10/14, 71%) involved the periphery of the flap and presented as palpable nodules. The remaining (4/14, 29%) involved the axilla and 3/4 (75%) were palpable. Imaging procedures detected infra-clinical ICRs in 3 of 10 imaged patients (30%). CONCLUSION ICRs after DIEP flap reconstruction are more frequent than contralateral recurrences suggesting the need for imaging follow-up of the reconstructed breast.
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Affiliation(s)
- J A Farras Roca
- Service d'imagerie médicale, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - T H Dao
- Service d'imagerie médicale, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - L Lantieri
- Service de chirurgie plastique et reconstructrice, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - C Lepage
- Service de chirurgie plastique et reconstructrice, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - R Bosc
- Service de chirurgie plastique et reconstructrice, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - E Meyblum
- Service d'imagerie médicale, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - F Pigneur
- Service d'imagerie médicale, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - P Beaussart
- Service d'imagerie médicale, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - E Assaf
- Service d'oncologie médicale, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - J L Totobenazara
- Service d'anatomo-pathologie, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - E Calitchi
- Service de radiothérapie, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - Y Belkacemi
- Service de radiothérapie, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Faculté de médecine, université Paris Est, Créteil, France
| | - A Rahmouni
- Service d'imagerie médicale, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Faculté de médecine, université Paris Est, Créteil, France
| | - A Luciani
- Service d'imagerie médicale, groupe Henri-Mondor-Albert-Chenevier, centre sein Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Faculté de médecine, université Paris Est, Créteil, France.
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Gazzola R, De Lorenzi F, Preda L, Veronesi G, Rietjens M. Chest Wall Resection for Single Rib Metastasis after Breast Cancer. Breast J 2015; 21:454-6. [PMID: 25950611 DOI: 10.1111/tbj.12432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Riccardo Gazzola
- Plastic Surgery Department, European Institute of Oncology, Milan, Italy
| | | | - Lorenzo Preda
- Radiology Department, European Institute of Oncology, Milan, Italy
| | - Giulia Veronesi
- Department of Early Diagnosis and Prevention of Lung Cancer, European Institute of Oncology, Milan, Italy
| | - Mario Rietjens
- Plastic Surgery Department, European Institute of Oncology, Milan, Italy
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Freyvogel M, Padia S, Larson K, Dietz J, Grobmyer S, O’Rourke C, Valente S. Screening Mammography Following Autologous Breast Reconstruction: An Unnecessary Effort. Ann Surg Oncol 2014; 21:3256-60. [DOI: 10.1245/s10434-014-3913-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Indexed: 11/18/2022]
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Cogliandro A, Cagli B, Filoni A, Cassotta G, Tenna S, Persichetti P. Expander/Implant breast reconstruction after reconstruction using an extended cutaneous thoracoabdominal flap: a case report. J Breast Cancer 2014; 16:438-41. [PMID: 24454467 PMCID: PMC3893347 DOI: 10.4048/jbc.2013.16.4.438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022] Open
Abstract
Many flaps have been described and are being used in the reconstruction of extensive tissue defects in the thoracic wall. The extended cutaneous thoracoabdominal flap, described in 2006, is an excellent option for chest wall reconstruction in patients with advanced breast cancer, being associated with a low morbidity rate and good functional results. The main disadvantage of this technique is the poor cosmetic outcome and the complete absence of a breast crease. We present the first case of a two-stage heterologous breast reconstruction after reconstruction using an extended cutaneous thoracoabdominal flap.
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Affiliation(s)
- Annalisa Cogliandro
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Barbara Cagli
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Angela Filoni
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gabriella Cassotta
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Stefania Tenna
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Persichetti
- Division of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Pitcher AA, Chao JW, Varma S, Swistel AJ, Otterburn DM. Recurrent breast cancer in the subpectoral space after implant reconstruction. J Surg Oncol 2013; 109:431-3. [PMID: 24258514 DOI: 10.1002/jso.23505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 10/25/2013] [Indexed: 12/29/2022]
Abstract
Breast reconstruction after mastectomy is most commonly performed with a prosthetic implant placed beneath the pectoralis major. Recurrence may rarely be identified in the subpectoral space where the implant was placed. We report a case of recurrent breast cancer after implant-based reconstruction with isolated subpectoral recurrence discovered 5 years later during secondary revision of her reconstructed breast.
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Affiliation(s)
- Austin A Pitcher
- Columbia University College of Physicians & Surgeons, New York, New York
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11
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Siponen ET, Joensuu H, Leidenius MHK. Local recurrence of breast cancer after mastectomy and modern multidisciplinary treatment. Acta Oncol 2013; 52:66-72. [PMID: 22971019 DOI: 10.3109/0284186x.2012.718793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To study the incidence of local recurrence (LR) of early breast cancer in the ipsilateral thoracic wall after mastectomy and outcome of patients with LR. MATERIAL AND METHODS A retrospective cohort study based on 2220 consecutive breast cancer patients treated at the Helsinki University Central Hospital, Finland, in 2000 to 2003. A subset of 755 (34.0%) patients had mastectomy which was usually followed by postoperative radiotherapy (51.2%) and/or systemic adjuvant therapy (79.2%). RESULTS During a median follow-up of 89 months, 22 (2.9%) patients treated with mastectomy had LR. The median time to LR was 27 months. None of the 12 patient- or tumour-related standard risk factors studied were independently associated with LR-free survival in a multivariate model. Six (27.3%) of the 22 patients with LR had distant metastases diagnosed either prior to or simultaneously with LR. The subset of 16 patients who were diagnosed with LR without concomitant distant recurrence had five-year breast cancer-specific survival of 77.5% as calculated from the date of LR detection, and overall survival of 59.2%. CONCLUSIONS LR after mastectomy has become a rare event. Most women with isolated LR survive for five years after LR.
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Affiliation(s)
- Elina T Siponen
- Breast Surgery Unit, Helsinki University Central Hospital, Helsinki, Finland.
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12
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Murthy V, Chamberlain RS. Nipple-sparing mastectomy in modern breast practice. Clin Anat 2012; 26:56-65. [PMID: 23168689 DOI: 10.1002/ca.22185] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 09/20/2012] [Indexed: 12/30/2022]
Abstract
Breast cancer management has evolved from the conventional radical Halsted to a fully integrated multidisciplinary approach. Nipple sparing mastectomy (NSM) is an innovative technique that preserves native breast envelope without mutilation of nipple-areola complex (NAC), thus providing a reasonable alternative for early cancers without NAC involvement and prophylactic high risk patients and avoids multiple surgical procedures required for reconstruction. This article aims to critically review indications, intra-operative protocols, radiotherapy planning and limitations of NSM. Patient selection should be based on study of breast duct anatomy by Magnetic Resonance Imaging, mammographic tumor-nipple distance and obligatory intra-operative frozen section from retro-areolar tissue. Tumor size, axillary lymph node status, lymphovascular invasion and/or degree of intraductal component are factors used to include NSM candidates based on institutional practice. Given the heterogeneity of patients and lack of standardization of preoperative investigations, surgical technique and pathologic sampling of retro-areola tissue so far, mandates a multi-institutional prospective study to define and validate a role for NSM in invasive breast cancer and DCIS. Nipple necrosis is an important NSM complication which can be greatly reduced using alternative skin incisions. Even if the nipple survives, an insensate nipple and lack of sexual function is common and requires preoperative counseling and discussion. Finally the relation and timing of intra-operative versus adjuvant breast radiation and tailoring of dosage and delivery methods has not been fully explored. Although NSM reduces psychological trauma associated with nipple loss, the oncologic safety as well as functional and aesthetic outcomes needs additional investigation.
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Affiliation(s)
- Vijayashree Murthy
- Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
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Murthy V, Chamberlain RS. Defining a Place for Nipple Sparing Mastectomy in Modern Breast Care: An Evidence Based Review. Breast J 2012; 19:571-81. [PMID: 22284266 DOI: 10.1111/j.1524-4741.2011.01220.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Vijayashree Murthy
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJDepartment of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USASaint George's University School of Medicine, Grenada, West Indies
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Management of local-regional recurrence following immediate breast reconstruction in patients with early breast cancer treated without postmastectomy radiotherapy. Plast Reconstr Surg 2011; 127:1763-1772. [PMID: 21532405 DOI: 10.1097/prs.0b013e31820cf24c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Young age is an independent risk factor for local-regional recurrence after mastectomy in patients with T1/T2 tumors with zero or one to three positive lymph nodes. The authors evaluated the current incidence and management of local-regional recurrence after immediate breast reconstruction in patients with T1/T2 tumors and zero to three positive lymph nodes who did not receive postmastectomy radiotherapy. METHODS Clinical and pathologic factors were identified for 495 patients with T1/T2 tumors and zero to three positive lymph nodes who were treated with mastectomy and immediate breast reconstruction between 1997 and 2002 and did not receive primary systemic chemotherapy or postmastectomy radiation therapy. RESULTS Autologous tissue-based reconstruction was performed in 70 percent of patients, and 30 percent had tissue expander placement. At a median follow-up of 7.5 years, local-regional recurrence had occurred in 16 patients (3.2 percent). Independent predictors of local-regional recurrence were age 40 years or less, estrogen receptor-negative tumors, and T2 (versus T1) tumors (p < 0.05). Multimodality therapy was utilized for all 16 patients with local-regional recurrence. Nine patients (56.3 percent) who had an isolated local-regional recurrence had a 100 percent local control rate and were treated with curative intent. The 10-year overall survival rate for patients with an isolated local-regional recurrence (87.5 percent) was not significantly different from that for patients without a local-regional recurrence (90.3 percent; p = 0.234). CONCLUSIONS Routine use of postmastectomy radiation therapy in this heterogeneous patient population should be discouraged to allow more patients to undergo immediate breast reconstruction and ease the burden on plastic surgeons who have had to confront the problems of reconstruction in the face of perioperative radiation in an ever-increasing number of patients.
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16
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Optimal Timing of Delayed Free Lower Abdominal Flap Breast Reconstruction after Postmastectomy Radiation Therapy. Plast Reconstr Surg 2011; 127:1100-1106. [DOI: 10.1097/prs.0b013e3182043652] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Koppert LB, van Geel AN, Lans TE, van der Pol C, van Coevorden F, Wouters MW. Sternal Resection for Sarcoma, Recurrent Breast Cancer, and Radiation-Induced Necrosis. Ann Thorac Surg 2010; 90:1102-1108.e2. [DOI: 10.1016/j.athoracsur.2010.06.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 06/04/2010] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
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18
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van der Pol CC, van Geel AN, Menke-Pluymers MBE, Schmitz PIM, Lans TE. Prognostic factors in 77 curative chest wall resections for isolated breast cancer recurrence. Ann Surg Oncol 2010; 16:3414-21. [PMID: 19672659 PMCID: PMC2779420 DOI: 10.1245/s10434-009-0662-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Indexed: 11/18/2022]
Abstract
Background Full-thickness chest wall resection (CWR) is the preferred treatment for breast cancer (BC) patients with extensive isolated locoregional recurrence. It remains a challenge to select patients that will benefit most from this treatment. The aim of this study was to define prognostic factors in patients who undergo CWR with curative intent. Methods BC patients who underwent a CWR with curative intent for recurrence of disease between 1986 and 2006 were included in this retrospective study. Twenty-two factors were studied in a univariate analyses, and multivariate stepwise Cox regression analyses was performed. Results Seventy-seven patients were included in this study. The 5-year overall survival was 25%. There was one postoperative death. Univariate analyses showed that three prognostic factors were significantly correlated with OS and disease-free survival: (1) interval between primary treatment and CWR (P = .02 and .004, respectively), (2) chemotherapy for recurrence (P = .05 and .05, respectively), and (3) resection specimen smaller than 150 cm2 (P = .03 and .009, respectively). An interval lasting >10 years between primary treatment and CWR remained statistically significantly correlated with better overall survival and disease-free survival after multivariate analyses. Conclusions CWR is a safe treatment in patients who have isolated extensive BC recurrence. The best survival outcome was seen in patients after a disease-free interval of ≥10 years. Existing data show that adjuvant radiotherapy and adjuvant hormone therapy for estrogen-positive tumors improves overall survival. Neoadjuvant chemotherapy may be considered in individual patients.
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Affiliation(s)
- Carmen C van der Pol
- Department of Surgical Oncology, Erasmus Medical Centre/Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
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19
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Chirurgie de reconstruction et radiothérapie du cancer du sein. IMAGERIE DE LA FEMME 2010. [DOI: 10.1016/j.femme.2010.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Zakhireh J, Fowble B, Esserman LJ. Application of Screening Principles to the Reconstructed Breast. J Clin Oncol 2010; 28:173-80. [DOI: 10.1200/jco.2008.21.7588] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A significant number of women choose mastectomy for the treatment of early and locally advanced breast cancer. Advances in reconstruction techniques and greater awareness of options have led to an increased use of immediate breast reconstruction, which has resulted in uncertainty for the management of surveillance for local recurrence. In this article, we review mastectomy and reconstruction trends and how these techniques affect the frequency and location of local recurrence. The data on surveillance imaging of the reconstructed breast are extremely limited. However, by assessing the potential role for imaging in this setting and applying the principles of screening, we have identified that there is a potential theoretic advantage of surveillance imaging in a very small subset of women: those with autologous tissue reconstructions and moderate to high risk of recurrence. A prospective registry study of surveillance imaging in this target population would be the appropriate way to determine its benefit and its impact on survival outcomes. In this review article, we will detail the reasons that should allow clinicians to forego routine surveillance imaging in the majority of women who undergo mastectomy and reconstruction.
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Affiliation(s)
- Jennifer Zakhireh
- From the Departments of Surgery and Radiation Oncology, University of California, San Francisco, CA
| | - Barbara Fowble
- From the Departments of Surgery and Radiation Oncology, University of California, San Francisco, CA
| | - Laura J. Esserman
- From the Departments of Surgery and Radiation Oncology, University of California, San Francisco, CA
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21
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Sirohi B, Leary A, Johnston SRD. Ipsilateral breast tumor recurrence: is there any evidence for benefit of further systemic therapy? Breast J 2009; 15:268-78. [PMID: 19645782 DOI: 10.1111/j.1524-4741.2009.00716.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To date, there are no standard guidelines for treating patients with ipsilateral breast tumor recurrence (IBTR). Current practice is to resect the recurrence with a radical intent followed possibly by radiotherapy if the patient has not received this before, but the role of further adjuvant medical (hormone or chemotherapy) therapy remains undefined. Currently Phase III trials are underway to answer this question. In this review, we will focus on published data relating to IBTR and discuss recent trials. The results from the Phase III trials will not be available for sometime. At the time of IBTR, it is reasonable to change the endocrine therapy with indirect evidence from sequencing of impact on outcome. There is currently no conclusive evidence to suggest that further adjuvant chemotherapy post loco-regional recurrence impacts on survival, though the use of noncross-resistant chemotherapy drugs may make sense in those at highest risk. Biopsy at IBTR is helpful to distinguish whether it is a true recurrence or a new primary tumor and receptor phenotyping may be helpful for HER2. Future trials in IBTR need to address the following issues: to be able to distinguish between true recurrence and new primary (consensus required on definitions); pathologic processing relating to margins needs to be standardized (1 or 5 mm wide specimens); documentation of the pattern of IBTR in relation to each histopathologic subtype and methods used for pathologic examination by centers. Regional nodal recurrence including supraclavicular node recurrence is not dealt with in this review.
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Affiliation(s)
- Bhawna Sirohi
- Breast Unit, Royal Marsden NHS Foundation Trust, Surrey, UK
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22
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Balch CM, Jacobs LK. Mastectomies on the rise for breast cancer: "the tide is changing". Ann Surg Oncol 2009; 16:2669-72. [PMID: 19644723 PMCID: PMC2749168 DOI: 10.1245/s10434-009-0634-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 07/07/2009] [Indexed: 12/28/2022]
Affiliation(s)
- Charles M. Balch
- Johns Hopkins Departments of Surgery and Oncology and the Avon Foundation Breast Center, Johns Hopkins Medical Institutions, Baltimore, MD USA
| | - Lisa K. Jacobs
- Johns Hopkins Departments of Surgery and Oncology and the Avon Foundation Breast Center, Johns Hopkins Medical Institutions, Baltimore, MD USA
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Fernández-Frías AM, Aguilar J, Sánchez JA, Merck B, Piñero A, Calpena R. Immediate reconstruction after mastectomy for breast cancer: which factors affect its course and final outcome? J Am Coll Surg 2008; 208:126-33. [PMID: 19228514 DOI: 10.1016/j.jamcollsurg.2008.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Revised: 08/13/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
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24
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Richards GM, Tomé WA, Robins HI, Stewart JA, Welsh JS, Mahler PA, Howard SP. Pulsed reduced dose-rate radiotherapy: a novel locoregional retreatment strategy for breast cancer recurrence in the previously irradiated chest wall, axilla, or supraclavicular region. Breast Cancer Res Treat 2008; 114:307-13. [PMID: 18389365 DOI: 10.1007/s10549-008-9995-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 03/26/2008] [Indexed: 12/29/2022]
Abstract
PURPOSE Reirradiation of breast cancer locoregional recurrence (LRR) in the setting of prior post-mastectomy radiation poses a significant clinical challenge due to the high risk for severe toxicity. In an attempt to reduce these toxicities, we have developed pulsed reduced dose-rate radiotherapy (PRDR), a reirradiation technique in which a series of 0.2 Gy pulses separated by 3-min time intervals is delivered, creating an apparent dose rate of 0.0667 Gy/min. Here we describe our early experience with PRDR. PATIENTS AND METHODS We reirradiated 17 patients with LRR breast cancer to the chest wall, axilla, or supraclavicular region using PRDR. The median prior radiation dose was 60 Gy. We delivered a median PRDR dose of 54 Gy (range 40-66 Gy) in 1.8-2.0 Gy per fraction. Eight patients received concomitant low dose capecitabine for radiosensitization. The median treatment volume was 2,084 cm(3) (range 843-7,881 cm(3)). RESULTS At a median follow-up of 18 months (range 4-75 months) only 2 patients have had tumor failure in the treatment region. Estimated 2-year local control rate is 92%. Treatment was well tolerated with 4 patients experiencing grade 3 acute skin toxicity. Despite a median cumulative dose of 110 Gy (range 80-236 Gy), there has been only one grade 3 and one grade 4 late toxicity. CONCLUSIONS With a median follow-up of 18 months, PRDR appears to be an effective method to reirradiate large volumes of previously irradiated tissue in selected patients with locoregional chest wall, axilla, and supraclavicular recurrences.
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Affiliation(s)
- Gregory M Richards
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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25
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Breast Cancer Recurrence following Prosthetic, Postmastectomy Reconstruction: Incidence, Detection, and Treatment. Plast Reconstr Surg 2008; 121:381-388. [DOI: 10.1097/01.prs.0000298316.74743.dd] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Persichetti P, Tenna S, Cagli B, Scuderi N. Extended cutaneous 'thoracoabdominal' flap for large chest wall reconstruction. Ann Plast Surg 2007; 57:177-83. [PMID: 16861999 DOI: 10.1097/01.sap.0000215253.54577.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Major chest wall reconstructions are usually required after radical excision of advanced cancer stages and large radionecrosis in patients with poor general conditions. Fasciocutaneous, muscular, and musculocutaneous flaps have all been described, with the last ones being commonly considered a first choice. The authors introduce an extended pure cutaneous flap from the omolateral thoracoabdominal area that is able to cover extensive defects. The vascular supply is provided by the lateral cutaneous branches from intercostal, subcostal, and lumbar arteries. Between February 2002 and 2005, 18 female patients underwent major chest wall reconstruction with this technique. Flap dimensions ranged between 15 x 15 and 25 x 30 cm. No major complications were registered. Four flaps sustained a partial loss at the distal margin but 1 case only required further surgical debridement. The extended cutaneous "thoracoabdominal" flap proved to be a quick, single-stage procedure with a low morbidity rate, specifically indicated in patients with a poor prognosis.
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Affiliation(s)
- Paolo Persichetti
- Division of Plastic Surgery, Campus Bio-Medico University, Rome, Italy.
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27
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Di GH, Yu KD, Wu J, Qi FZ, Lu JS, Shen ZZ, Shao ZM. Immediate breast reconstruction with latissimus dorsi musculocutaneous flap: A suitable option for chinese women after mastectomy. Chin J Cancer Res 2006. [DOI: 10.1007/s11670-006-0088-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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