Breast Cancer and Secondary Cancer Recurrences After Autologous Tissue Reconstruction

  • Amy P. Early
    Address for correspondence: Amy P. Early, MD, Roswell Park Comprehensive Cancer Center, Roswell Park Amherst Center, 100 College Pkwy, Buffalo, NY 14221
    Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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  • Wong Moon
    Department of Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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Published:August 03, 2020DOI:



      The medical literature defining breast cancer recurrence and secondary cancers after autologous tissue reconstruction for breast cancer is sparse. We sought to identify and analyze occurrences at our institution.

      Patients and Methods

      A 20-year retrospective review of cancer recurrences and atypical breast neoplasms after autologous tissue breast reconstruction at Roswell Park Comprehensive Cancer Center was conducted after being granted a waiver from the institutional review board.


      Eighteen locoregional recurrences among 337 cases were identified and analyzed. Overall recurrence rate was 5.3%. Four secondary cancers (1.2%) were radiation-induced angiosarcoma, undifferentiated pleomorphic sarcoma, and metaplastic carcinoma. One case of flat epithelial atypia was identified.


      Our retrospective review found incidence and survival after treatment of breast cancer concordant with reports in the literature. We also identified and analyzed secondary neoplasms, including a unique case of undifferentiated pleomorphic sarcoma and metachronous recurrence of breast carcinoma. A case of recurrence as metaplastic carcinoma was identified.


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        • Slavin S.A.
        • Love S.M.
        • Goldwyn R.M.
        Recurrent breast cancer following immediate reconstruction with myocutaneous flaps.
        Plast Reconstr Surg. 1994; 93: 1191-1204
        • Kroll S.S.
        • Schusterman M.A.
        • Tadjalli H.E.
        • Singletary S.W.
        • Ames F.C.
        Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy.
        Ann Surg Oncol. 1997; 4: 193-197
        • Kroll S.S.
        • Khoo A.
        • Singletary S.E.
        • et al.
        Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up.
        Plast Reconstr Surg. 1999; 104: 421-425
        • Langstein H.N.
        • Cheng M.H.
        • Singletary S.E.
        • et al.
        Breast cancer recurrence after immediate reconstruction: patterns and significance.
        Plast Reconstr Surg. 2003; 111: 712-720
        • Spiegel A.H.
        • Butler C.E.
        Recurrence following treatment of ductal carcinoma in situ with skin-sparing mastectomy and immediate breast reconstruction.
        Plast Reconstr Surg. 2003; 111: 706-711
        • Howard M.D.
        • Polo K.
        • Pusic A.L.
        • et al.
        Breast cancer local recurrence after mastectomy and TRAM flap reconstruction: incidence and treatment options.
        Plast Reconstr Surg. 2006; 117: 1381-1386
        • Yi M.
        • Kronowitz S.J.
        • Meric-Bernstam F.
        • et al.
        Local, regional, and systemic recurrence rates in patients undergoing skin-sparing mastectomy compared with conventional mastectomy.
        Cancer. 2011; 117: 916-924
        • Reddy S.
        • Colakoglu S.
        • Curtis M.S.
        • et al.
        Breast cancer recurrence following postmastectomy reconstructions compared to mastectomy with no reconstruction.
        Ann Plast Surg. 2011; 66: 466-471
        • Patterson S.G.
        • Teller P.
        • Iyengar R.
        • et al.
        Locoregional recurrence after mastectomy with immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction.
        Ann Surg Oncol. 2012; 19: 2679-2684
        • Liang T.J.
        • Wang B.W.
        • Liu S.I.
        • et al.
        Recurrence after skin-sparing mastectomy and immediate transverse rectus abdominis musculocutaneous flap reconstruction for invasive breast cancer.
        World J Surg Oncol. 2013; 11: 194-200
        • Yoo H.
        • Kim B.H.
        • Kim H.H.
        • Cha J.H.
        • Shin H.J.
        • Lee T.J.
        Local recurrence of breast cancer in reconstructed breasts using TRAM flap after skin-sparing mastectomy: clinical and imaging features.
        Eur Radiol. 2014; 24: 2220-2226
        • Yang X.
        • Zhe C.
        • Gu Y.
        The prognosis of breast cancer patients after mastectomy and immediate breast reconstructions: a meta-analysis.
        PLos One. 2015; 10: e0125655
        • Ha J.H.
        • Hong K.Y.
        • Lee H.B.
        • et al.
        Oncologic outcomes after immediate breast reconstruction following mastectomy: comparison of implant and flap using propensity score matching.
        BMC Cancer. 2020; 20: 78
        • Shaikh N.
        • LaTrenta G.
        • Swister A.
        • Osborn M.
        Detection of recurrent breast cancer after TRAM flap reconstructrion.
        Ann Plast Surg. 2001; 47: 602-607
        • Helvie M.A.
        • Bailey J.E.
        • Roubidoux M.A.
        • et al.
        Mammographic screening of TRAM flap breast reconstructions for detection of nonpalpable recurrent cancer.
        Radiology. 2002; 224: 211-216
        • Edeiken B.S.
        • Fornage B.D.
        • Bedi D.G.
        • Sneige N.
        • Parulekar S.G.
        • Pleasure J.
        Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis.
        Radiology. 2003; 227: 542-548
        • Zakhireh J.
        • Fowble B.
        • Essarman L.J.
        Application of screening principles to the reconstructed breast.
        J Clin Oncol. 2010; 28: 173-180
        • Pinel-Giroux F.M.
        • El Khoury M.M.
        • Trop I.
        • Bernier C.
        • David J.
        • Lalonde L.
        Breast reconstruction: review of surgical methods and spectrum of imaging findings.
        Radiographics. 2013; 33: 435-453
        • Freyvogal M.
        • Padia S.
        • Larson K.
        • et al.
        Screening mammography following autologous breast reconstruction: an unnecessary affort.
        Ann Surg Oncol. 2014; 21: 3256-3260
        • Tropp I.
        Is there a role for imaging surveillance after mastectomy and autologous breast reconstruction?.
        Radiology. 2018; 289: 49-50
        • Noroozian M.
        • Carlson L.W.
        • Savage J.L.
        • et al.
        Use of screening mammograms to detect occult malignancy in autologous breast reconstructions: a 15-year experience.
        Radiology. 2018; 289: 39-48
        • American College of Radiology
        ACR Appropriate Criteria® imaging after mastectomy and breast reconstruction.
        (Available at:)
        • Torresan R.Z.
        • dos Santos C.C.
        • Okamura H.
        • Alverenga M.
        Evaluation of residual glandular tissue after skin-sparing mastectomies.
        Ann Surg Oncol. 2005; 12: 1037-1044
        • Hedegard W.
        • Niell B.
        • Specht M.
        • Winogard H.
        • Rafferty E.
        Breast reconstruction with a deep inferior epigastric perforator flap: imaging appearance of the normal flap and common complications.
        Am J Roentgenol. 2013; 200: W75-W84
        • Chung S.M.
        • Shin S.J.
        • Chen X.
        • Rosen P.P.
        Recurrent breast carcinoma arising in a transverse rectus abdominis myocutaneous flap.
        Arch Pathol Lab Med. 2004; 128: 1157-1160
        • Vugts G.
        • Maaskant-Braat A.J.
        • Voogd A.C.
        • et al.
        Repeat sentinel node biopsy should be considered in patients with locally recurrent breast cancer.
        Breast Cancer Res Treat. 2015; 153: 549-556
        • Huskies J.V.M.
        • Keemers-Gels M.E.
        • Fabré J.
        • Strobbe L.J.A.
        DIEAP flap breast reconstruction followed by local recurrence of breast cancer.
        Case Rep Oncol. 2018; 11: 493-498
        • Schnitt S.J.
        The diagnosis and management of pre-invasive breast disease: flat epithelial atypia—classification, pathologic features, and clinical significance.
        Breast Cancer Res. 2003; 5: 263-268
        • Said S.M.
        • Visscher D.W.
        • Nassar A.
        • et al.
        Flat epithelial atypia and risk of breast cancer: a Mayo cohort study.
        Cancer. 2015; 121: 1458-1465
        • Yap J.
        • Chuba P.J.
        • Thomas R.
        • et al.
        Sarcoma as a second malignancy after treatment for breast cancer.
        Int J Radiat Oncology Biol Phys. 2002; 52: 1231-1237
        • Erel E.
        • Vlachou M.
        • Athanasaidou M.
        • Hassan S.
        • Chandrasekar C.R.
        • Peart F.
        Management of radiation-induced sarcomas in a tertiary referral centre.
        Breast. 2010; 19: 424-427
        • Sheth G.R.
        • Cranmer L.D.
        • Smith B.D.
        • Grasso-LeBeau L.
        • Lang J.E.
        Radiation-induced sarcoma of the breast: a systematic review.
        Oncologist. 2012; 17: 405-418
        • Cohen-Hallaleh R.B.
        • Smith H.G.
        • Smith R.C.
        • et al.
        Radiation induced angiosarcoma of the breast: outcomes from a retrospective case series.
        Clin Sarcoma Res. 2017; 7: 15
        • Feinberg L.
        • Srinivasan A.
        • Singh J.K.
        • et al.
        Impact of specialist management on survival from radiation-associated angiosarcoma of the breast.
        Br J Surg. 2018; 105: 401-410
        • Hanoso M.M.
        • Osborne M.P.
        • Dielubanza E.J.
        • Peters S.B.
        • Gayle L.B.
        Radiation-induced angiosarcoma after mastectomy and TRAM flap breast reconstruction.
        Ann Plast Surg. 2005; 54: 211-214
        • Olcina M.
        • Merck B.
        • Giménez-Climent M.J.
        • et al.
        Radiation-induced leiomyosarcoma after breast cancer treatment and TRAM flap reconstruction.
        Sarcoma. 2008; 2008: 456950
        • Aljarrah A.
        • Nos C.
        • Clough K.B.
        • Lefere-Belda A.
        • Lecuru F.
        A case report on radiation-induced angiosarcoma of breast post skin-sparing mastectomy and reconstruction with transverse rectus abdominal muscle.
        Ecancermedicalscience. 2014; 8: 402
        • Yip C.
        • Weiler-Mithoff E.
        • Doughty J.C.
        • Lo S.J.
        Radiation-associated angiosarcoma after autologous breast reconstruction: report of two cases in a plastic surgery unit.
        Eur J Plast Surg. 2019; 42: 513-516