Breast Reconstruction in Metastatic Breast Cancer: Report of an Institutional Experience and Review of Literature

Purpose Breast reconstruction (BR) in metastatic breast cancer (MBC) patients is a growing demand. We considered that properly selected patients would benefit from BR. Our aim was to provide recommendations based on our experience and according to the published literature. Methods A retrospective review of the cases of 5 MBC women who underwent BR at Hospital Universitario La Paz, from April 2012 to March 2016, was made. Results The average age was 47.2 years. All patients had bone metastases, multicentric breast tumor and axillary involvement at diagnosis. Chemotherapy as first-line therapy was given to 80% and radiotherapy in 60% of BR patients. All women undergone modified radical mastectomy and axillary lymphadenectomy, and 3 patients received immediate BR and 2 deferred. The types of BR performed were 3 latissimus dorsi myocutaneous flap (combined with an implant or expander), an expander and a Becker expander implant. Two patients had complications, and 66.7% of expanders were removed. During an average follow-up of 31.5 months, 2 patients died and only one had a local relapse. Conclusions In selected patients with MBC at diagnosis and after assessing response to systemic treatment, BR could be performed, upon request and acceptance. Individualized surgery is recommended, trying to choose the least aggressive surgical procedure as possible. A protocol with a unified approach is required considering an increased demand of this kind of procedure in anticipation of a major future requirement.