Can Breast Cancer return in a Reconstructed Breast?

Some women are scared to consider breast reconstruction after a mastectomy because they think it will increase the risk of the breast cancer coming back. This is a common misconception. Thankfully, it's not the case.


Breast cancer can come back even after a mastectomy. However, the risk of the cancer returning (ie a "recurrence") after a mastectomy is very low and is the same whether you have breast reconstruction or not. Studies have compared patients with similar stage breast cancers and found no difference in recurrence between patients undergoing mastectomy alone (without reconstruction) and those having skin-sparing mastectomy and reconstruction.


When the patient's own tissue is used for the reconstruction (as in a "flap" procedure), only skin, fat, and (sometimes) muscle are used. This tissue is used to replace breast tissue and feels like a breast, but it never turns into real breast tissue. Since it isn't real breast tissue, the flap doesn't increase the risk of a new cancer forming. 


While it is possible for breast cancer to recur after a mastectomy, breast reconstruction (either with an implant or flap) does not increase the risk of a new cancer forming, or the previous cancer returning.


I hope this info helps.


Dr C


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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. We are In-Network for most US insurance plans and routinely welcome patients from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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Mammograms after Breast Reconstruction - Are They Really Needed?

"Do I still need to have mammograms after my breast reconstruction?" I'm asked this question quite often.

Surprisingly, there is no evidence-based consensus on this amongst breast cancer physicians.
Some doctors feel that since there is no "natural" breast tissue left, there is no need to continue monitoring patients. Others decide on a patient-by-patient basis.

Though the risk is very low, breast cancer can come back after a mastectomy. Breast reconstruction does not increase or decrease the risk of recurrence at all - the recurrence rate is the same whether women have reconstruction or not.

However, since the risk of breast cancer recurrence is a real one, I feel we need to continue some sort of monitoring once the reconstruction process is completed. This is especially the case in nipple-sparing mastectomy patients and patients who carry breast cancer associated gene mutations (eg BRCA).

Self breast exam is a no-brainer. It's relatively easy to perform and it's free.

For implant reconstruction patients it’s easier to feel changes in the skin against the underlying implant. Deep recurrences on the muscle (less common) are also theoretically easier to feel; the pectoralis muscle previously located under the breast tissue (ie at the "deep mastectomy margin") is now displaced superficially and under the skin since it is pushed upwards by the implant placed beneath it.

For patients with silicone implants, the FDA recommends an MRI 3 years after the implants are placed followed by repeat MRIs every 2 years after that. This recommendation was provided when silicone implants were re-introduced to the US market for cosmetic use as a means of checking implant integrity long-term. In the case of breast reconstruction, recurrent cancer is always going to be a more worrying concern for patients than documenting implant integrity. However, the MRI test is the same in both instances. Ironically, when it comes to having the MRI covered by insurance, it is often easier to use the FDA recommendation as the underlying reason for having the test rather than trying to justify a screening test in a mastectomy patient with a benign exam. I don't personally feel routine MRIs are necessary but this approach is certainly an option.

Patients that have had a flap reconstruction may also benefit from further imaging studies in addition to self exam.

The most commonly used breast imaging studies are mammograms and MRI. The appearance of a mammogram changes completely after autologous (flap) breast reconstruction. Even if the breast looks naturals on the outside, the inside of the breast is completely different since the breast tissue has been replaced by fat.

Some surgeons recommend flap patients have a mammogram, in essence a "flapogram", after reconstruction just to get a new baseline. If the self breast exam reveals anything new of concern then the mammogram can be repeated, often in conjunction with an ultrasound for more information. Now the new mammogram can be compared to the baseline mammogram.

Another option is a one-off baseline MRI after breast reconstruction instead of a mammogram but this is a more expensive approach. MRIs are much more sensitive. Again, if self breast exam reveals a new area of concern in the future, the MRI can be repeated to see if anything has changed.

The counter argument to this approach is that any new breast lumps that appear in the future will likely lead to the recommendation for a biopsy anyway, so what is the point of getting a baseline mammogram or MRI at all?

I understand this point of view but I don't agree with it. Flap reconstructions can develop areas of fat necrosis. This is fat in the reconstructed breast that becomes hard and creates a new mass. While a biopsy may indeed be planned anyway to rule out a recurrence, there is a lot to be said for the physician and patient knowing this "lump" has been there all along and that the chance of this representing a new cancer is extremely low. The additional information and peace of mind a baseline study provides in this situation warrants it in my opinion.

I hope this info helps!

Dr C

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Dr Chrysopoulo is a breast reconstruction surgeon in San Antonio, TX, specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer on Facebook.

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Breast Cancer Recurrence Not Related To Method Of Breast Reconstruction

One of my breast cancer patients called me today. She recently underwent bilateral mastectomies and immediate breast reconstruction with DIEP flaps. She recovered very well from the surgery but unfortunately her pathology results showed that she had cancer extending almost to the edge of the mastectomy specimen. The exact medical jargon used by the pathologist was.... "invasive carcinoma extending to 1mm from the margin". She also had DCIS (ductal carcinoma in situ) "extending to 0.2mm from the margin."

From a purist's perspective, these results still represent "clear margins". In other words, no tumor was found at the edge of the mastectomy specimen so there is no reason to believe there is any cancer left in my patient's breast. BUT, it's very close and that is certainly worrisome.

She called me today because she visited with her oncologist (cancer doc) and a radiation oncologist (cancer doc specializing in radiotherapy) and radiation therapy was recommended (in addition to the planned chemotherapy).

She explained to the radiation oncologist that she was worried the radiation therapy would ruin her DIEP flap reconstruction. She is right to be fearful of this - patients undergoing radiation therapy after an autologous reconstruction (ie a reconstruction using their own tissue) have a 28% risk of needing further surgery to correct asymmetry caused by the radiation changes (usually firming and shrinking) of the irradiated breast.

The response she received from the radiation oncologist baffled me (and is actually the reason behind this blogpost)...... "DIEP flap? What's a DIEP flap?.... if you'd had a TRAM flap then you wouldn't be needing radiation".

What?

This is a ridiculous statement. Let me clarify why...

This lady is being recommended radiation therapy as an insurance policy to decrease the risk of local recurrence (cancer coming back in the same breast). This is a consequence of her "near margins" which in turn are a result of the mastectomy specimen. Obviously the mastectomy was completed before the reconstruction was even started. If this lady had only had the mastectomy (without reconstruction) the margins would be the same. The breast reconstruction, and moreover, the type of breast reconstruction has absolutely nothing to do with it. The margins, the pathologist reading and the recommendation for radiation therapy would have been exactly the same whether reconstruction was performed or not.

So what's the take home message if you're considering breast reconstruction surgery? Choose whichever method of reconstruction is best for you. Your decision will not influence the likelihood of your cancer coming back in any way. The risk of cancer recurrence is related to the characteristics of the cancer itself and the mastectomy margins, not the method of reconstruction.

Dr C

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Dr Chrysopoulo is a board certified breast reconstruction surgeon specializing in DIEP flap breast reconstruction surgery. He and his partners perform over 350 DIEP flap procedures each year with a success rate of over 99%. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Cancer Reconstruction Blog.

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DIEP Flap Reconstruction And Breast Cancer Recurrence

Can DIEP flap breast reconstruction prevent detection of breast cancer recurrence? This is a very important issue that is often not discussed.

A handful of studies have shown that breast reconstruction (with any reconstructive technique) does not impact local recurrence or long term survival in patients with early breast cancer (stage I and II). The rate of local recurrence and length of survival is the same in patients with stage I and II disease whether they undergo immediate breast reconstruction (ie reconstruction at the same time as mastectomy) or not. For this reason most institutions (including ours) offer breast cancer patients with early disease immediate breast reconstruction whenever possible.

Patients diagnosed with advanced disease are more likely to be candidates for delayed breast reconstruction once they have undergone mastectomy, completed their cancer treatment and remained disease free for several months.

Breast reconstruction (with a DIEP flap or any other method) does not encourage or enhance breast cancer recurrence or shorten long term survival in any way.

Dr C

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Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including DIEP flap reconstruction. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

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