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Autologous Free Flap Reconstruction for Inflammatory Breast Cancer: 10 Year Experience
Edward I. Chang, MD, Eric I. Chang, MD, Gildy V. Babiera, MD, Anthony Lucci, MD, Thomas A. Buchholz, MD, Naoto T. Ueno, MD, Kelly K. Hunt, MD, Geoffrey L. Robb, MD, David W. Chang, MD.
MD Anderson Cancer Center, Houston, TX, USA.

ABSTRACT
Purpose: Inflammatory breast cancer (IBC) is a relatively rare but aggressive type of breast cancer with an overall poor prognosis. There are virtually no studies substantiating reconstruction for these patients and traditionally they have not been offered reconstruction. Here we present the largest study in the literature examining autologous free flap reconstruction for IBC patients.
Methods: Retrospective analysis of all patients’ medical records undergoing treatment for IBC from January 2000_present at a single academic institution.
Results: Overall 47 patients underwent free autologous tissue reconstruction following mastectomy for inflammatory breast cancer. The average age of diagnosis is 49.0 years (range 28-65), and 13 patients had a history of smoking. All patients in the cohort received radiation therapy and chemotherapy with 5 patients undergoing immediate reconstruction and the remainder undergoing reconstruction in a delayed fashion. Ten patients underwent a contralateral prophylactic mastectomy and one patient had bilateral breast cancer, and all subsequently underwent bilateral free flap reconstruction. Six patients underwent a bipedicle abdominal flap to reconstruct the unilateral mastectomy defect. Overall, 19 patients (40.4%) developed complications with one patient who developed a pulmonary embolus. Six patients (12.8%) developed wound-healing complications with the flap inset into the radiated field, and 5 patients (11.1%) also developed donor site complications. Three patients developed significant fat necrosis requiring treatment. Two patients were taken back to the operating room for venous congestion and salvaged with additional outflow utilizing the superficial system. There was one total flap loss (2.1%) secondary to arterial and venous thrombosis. Average length of follow-up is 46.8 months with 41 patients (87.2%) currently without evidence for disease.
Conclusion: Historically, patients undergoing treatment for inflammatory breast cancer have had poor long-term survival and have not been considered candidates for breast reconstruction. Here, we demonstrate that IBC should not be a contraindication for autologous free flap breast reconstruction. Patients with IBC should be offered free flap breast reconstruction which can be performed safely with acceptable complication rates without increased risk for flap loss.


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