Recurrent breast carcinoma at the time of breast reconstruction

Detection of recurrent breast carcinoma following reconstruction of mastectomy defects is of concern to plastic surgeons and oncologists. During the past four years we have found recurrent, previously undetected breast cancer in 4 patients at the time of reconstruction. The recurrent disease presented differently in each patient: as fascial thickening, as a small node hidden under a pectoralis muscle stump, as a microscopical tumor contained within the mastectomy scar, and as a small mass which developed during the interim between the last office visit and the scheduled surgery. All of the patients received additional treatment and one has been reconstructed. Our study of these patients prompts the following recommendations: (1) carefully reexamine the patient just prior to reconstruction; (2) biopsy any abnormal tissue; (3) submit all excised mastectomy scars for histological examination; (4) create and examine the recipient pocket before raising a flap; and (5) reconsider the patient for reconstruction following additional cancer therapy.