Impact of chest wall perforator flap reconstruction on mastectomy in breast cancer

ABSTRACT

Introduction: Breast conserving surgery (BCS) has comparable or superior oncological safety when compared to mastectomy and is associated with improved cosmetic and psychological outcome. Previously patients with larger tumour to breast ratios were not suitable for BCS due to poor aesthetic outcomes and hence underwent total mastectomy with or without reconstruction. With the introduction of chest wall perforator flaps (CWPF), a significant proportion of these women who would have otherwise undergone mastectomy, can now qualify for BCS along with volume replacement. The objective of our study was to find out the impact of CWPFs on mastectomy and reconstruction. Methods: All patients who underwent surgery for breast cancer from January 2016 to December 2019 were included in the study to know the impact of CWPF on rates of mastectomy and other procedures. We excluded 2020-21 due to alterations in breast cancer treatment due to COVID-19 pandemic. The study was registered and approved by the local Clinical Governance department at the University Hospitals of North Midlands NHS Trust (CA12119). Results: Following the introduction of CWPF reconstruction, the mastectomy rate (including reconstruction) dropped by 10.69% (from 215 mastectomies in 2016 to 192 in 2019) and the mastectomy with reconstruction rate dropped by 23.29% (from 73 in 2016 to 56 in 2019). This change can be attributed to the use of CWPFs (from 1 in 2016 to 51 in 2019). Conclusion: CWPF reconstruction has reduced the rates of mastectomy +/- reconstruction and can potentially improve overall patient outcome.