Recurrance in Reconstructed Breast?

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Anonymous
Anonymous Member Posts: 1,376
edited June 2014 in Not Diagnosed With a Recurrence or Metastases but Concerned

Hi everyone,  I am stopping in here to find out how common it is to have a recurrance in a reconstructed "Free Tram Flap" breast reconstruction.  The reason I am asking is because I've been having some sensitivity in little lumpy parts (nodes on chest wall???) above the breast mound.  I'm wondering if anyone here has felt a little sore lumpy areas around the chest wall and clavicle area in the original cancerous side. Thank you for any helpful comments.Smile

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  • Nichola
    Nichola Member Posts: 402
    edited September 2013

    Hi DanaGirl

    I think it is extremely rare to get a recurrence in the tram flap itself, but although still rare, you can get a recurrence in the areas outside the flap:  These lumps are usually in the skin and/or usually on or next to the scar line or on the chest wall or nodes nearby.  Having been one of those extremely rare cases, I can tell you that that neither of my recurrences were sore to the ouch.  I still have loads of hard lumpy areas which are scar tissue.

    A sore swollen node is usually attributed to be reactive to infection.

    I hope this helps...

    N x

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited September 2013

    Hi Nichola,  I also had thought it was rare for recurrance in reconstructred tram breast; however i was wondering about some bumpy area around my incisional area. I snipped this article and was thinking of disucssing it with my onc.

    Mammographic Screening of TRAM Flap Breast Reconstructions for Detection of Nonpalpable Recurrent Cancer1

    1. 1From the Departments of Radiology (M.A.H., J.E.B., M.A.R.), Surgery (H.A.P., A.E.C., E.G.W.), and Radiation Oncology (L.J.P.), University of Michigan Health System, 1500 E Medical Center Dr, Taubman Center 2910N, Ann Arbor, MI 48109-0326. From the 1999 RSNA scientific assembly. Received November 29, 2000; revision requested January 4, 2001; revision received September 24; accepted February 1, 2002. Address correspondence to M.A.H.


     

    Abstract

    PURPOSE: To evaluate findings from routine mammographic screenings in patients with transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions.

    MATERIALS AND METHODS: During a 25-month study period, 214 consecutive screening mammograms in 113 asymptomatic women (mean age, 51 years) with TRAM flap reconstructions were obtained. Mastectomies were performed for cancer in 106 (94%) of the 113 women and for prophylaxis in seven (6%). Prospectively, a Breast Imaging Reporting and Data System (BI-RADS) assessment category 1–5 was assigned to each mammogram. Surgical, medical, pathologic, and radiographic records were retrospectively reviewed. CIs were determined by the normal approximation to the binomial distribution.

    RESULTS: Seven (3%) of 214 examinations were BI-RADS category 4 or 5. Six (86%) of seven patients underwent biopsy. Two (33%) of these six biopsies demonstrated invasive ductal carcinoma. Cancer detection rate for mammography was 1.9% (two of 106) (95% CI: 0.33%, 7.32%) for women with reconstruction for breast cancer during the 2-year period. One (6%) of 16 BI-RADS category 3 examinations later proved to be invasive ductal carcinoma at follow-up. No interval cancer was discovered in 171 cases of BI-RADS category 1 or 2 examinations with 1-year follow-up. No cancers occurred in women who underwent prophylactic mastectomy. A biopsy positive predictive value of 33% (95% CI: 6%, 76%) was observed.

    CONCLUSION: Screening mammography of TRAM flap–reconstructed breasts enables detection of nonpalpable cancer before clinical examination.




    Breast reconstruction following mastectomy for carcinoma is frequently elected by women. Historically, silicone implants were the most common method of breast reconstruction. More recently, autologous tissue reconstruction has gained in popularity in part owing to adverse publicity regarding prosthetic implant safety. The most common method of autologous reconstruction is the transverse rectus abdominis musculocutaneous (TRAM) flap. This technique uses lower abdominal skin, subcutaneous fat, and rectus muscle to reconstruct the breast (1).

    Recurrent breast cancer following reconstruction, although uncommon, has been reported (2–10), with 4%–11% of patients developing recurrence in the TRAM-reconstructed breast, most within the first 5 years. Annual incidence of 1% has been reported (9). Because widespread use of TRAM reconstruction is relatively new, the true long-term incidence will likely not be known for some time. Annual local recurrence rates following mastectomy without reconstruction range from 0.2% to 1% (11). The biologic and clinical importance of TRAM recurrence is incompletely understood. TRAM recurrence may be a manifestation of systemic disease or may represent the only focus of invasive carcinoma. Therefore, the role of early detection of local recurrence is not clear, and further studies will be necessary to assess the effect on morbidity and survival.

    Surveillance of the TRAM-reconstructed breast for cancer detection often has been performed with regular clinical breast examination (6,12,13), although some sites routinely perform mammography as well. Those who use clinical examination alone believe that physical examination allows early detection and note the paucity of studies in which the efficacy of mammographic screening of TRAM recurrence (12) is assessed. In contrast, surveillance following breast-conserving therapy (BCT) is performed with both annual mammography and regular clinical breast examination. The annual incidence (1%–2%) of recurrence after BCT is similar to that of TRAM recurrence (14). Because mammography enables detection of nonpalpable recurrence at a smaller size than does clinical examination, screening patients with TRAM reconstruction after mastectomy for cancer may be reasonable. Screening may be especially relevant in those patents who have undergone mastectomy and TRAM flap reconstruction for early stage carcinoma without metastatic disease.

    The purpose of our study was to evaluate findings from routine mammographic screenings in patients with TRAM flap reconstructions.




    MATERIALS AND METHODS

    Patients

    Institutional review board approval was obtained and did not require patient informed consent for this retrospective study. During a 25-month study period (September 1997 to October 1999), we performed 214 consecutive screening mammographic examinations on TRAM flap–reconstructed breasts following mastectomy in 113 patients. The study population included 113 women who underwent unilateral (103 patients [91%]) or bilateral (three patients [3%]) mastectomy for carcinoma (106 patients [94%]) or for prophylaxis (seven patients [6%]). All patients were asymptomatic women (no palpable abnormality at clinical breast examination performed by a breast imaging examiner or by the patient’s physician, or no reported abnormality at self-examination by the patient). The decision to perform mammography was made clinically by the patients’ oncologist, surgeon, or plastic surgeon based, in part, on institutional experience with numerous palpable TRAM recurrences and their imaging findings. During the study, 49 (43%) of the 113 women had one mammogram, 51 (45%) had two mammograms, and 13 (12%) had three or more mammograms (mean number of mammograms per patient was 1.7). Patients’ ages ranged from 35 to 75 years (median age, 49 years; mean age, 51 years) at the time of examination.

    Patients who underwent their primary surgical treatment at our institution, a National Cancer Institute–designated Comprehensive Cancer Center, were treated with mastectomy by a surgical oncologist and with TRAM flap reconstruction by a plastic surgeon. Patients’ ages at time of mastectomy ranged from 29 to 66 years (median age, 44 years; mean age, 46 years). Reconstruction occurred either at the time of mastectomy or at a later date. Patients who underwent surgical treatment outside our institution, but were being followed up by an oncologist at this institution, were also included. Surgical, medical, pathologic, and radiographic records were retrospectively reviewed, with data entered into a standard database (Excel; Microsoft, Seattle, Wash). Data reviewed (J.E.B., M.A.H.) were patient age, initial biopsy report, subsequent biopsy report, date of TRAM, date of mammography, prospective mammographic assessment, ultrasonographic (US) findings, duration of follow-up, and disease status at follow-up (until March 2001).




    Mammography, Interpretation, and Biopsy

    Mammography was performed following the standard technique used for nonreconstructed breasts. Initial routine screening mammography of TRAM-reconstructed breasts was a three-view study—craniocaudal, mediolateral oblique, and lateral views—with use of the same institutional protocol as that for the first screening mammographic examination for patients who underwent interval surgical biopsy. Subsequent yearly screening mammograms of the TRAM-reconstructed breast were obtained by using a two-view technique—craniocaudal and mediolateral oblique views. Mammography equipment (DMR; GE Medical Systems, Milwaukee, Wis) was set in the “contrast” mode, unless thickness exceeded 6 cm in which case the “standard” mode was used. The site was a Mammography Quality Standards Act– and State-certified facility. Study findings were interpreted by a breast radiologist, who fulfilled Mammography Quality Standards Act requirements to interpret mammograms, while the patient remained in the department. Any additional views or breast US scans were obtained at the time of the initial visit.

    All mammograms had been prospectively assessed by using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) (15): category 1, negative; 2, benign; 3, probably benign; 4, suspicious; and 5, highly suggestive of a malignancy. Patients with category 1 or 2 mammograms were recommended for routine annual mammography. Patients with category 3 lesions were recommended for short-term mammographic follow-up at 4–6 months. Patents with category 4 or 5 lesions were recommended for biopsy.

    Biopsy of BI-RADS categories 4 and 5 lesions was performed by means of image-directed core-needle biopsy or wire localization biopsy. Fine-needle aspiration was recommended for lesions believed to represent complex cysts or for lesions in which core biopsy was technically impossible. Image-guided biopsy techniques were similar to those of native breasts. The major vascular supply to the TRAM flap was known before biopsy because, TRAM reconstruction may be performed as a pedicle flap, with the inferior epigastric blood vessels coming from the lower inner quadrant, or as a free flap, with inferior epigastric or thoracodorsal anastomosis entering from the upper outer quadrant (13,16). In each biopsy case, we consulted with the surgeon to ensure that there would be no risk of traversing the TRAM vascular supply via the biopsy approach chosen.

    Mammographic technique in patients with TRAM reconstructions was not substantially different from that of routine screening of native breasts or breasts after lumpectomy. The compressed thickness of TRAM-reconstructed breasts was greater than normal, with a mean thickness of 6.3 cm. However, because most of the tissue was fatty, this did not create a problem with penetration. Mammographic technical factors recorded on the patient’s mammogram, including kilovolt peak, milliampere second, and compressed breast thickness (craniocaudal view), were tabulated for each patient’s examination. The posterior nipple line length on the craniocaudal view was measured by hand retrospectively.

    Breast US (model 700; GE Medical Systems) with 7–12-MHz transducers was performed by the radiologist to characterize a mammographic mass. Results were categorized as a simple cyst, complex cyst, solid mass, or negative.




    Statistical Analysis

    True-positive assessments were defined as a mammographic assessment category 4 or 5 and a histologic diagnosis of carcinoma. Lobular carcinoma in situ was not considered a carcinoma for this analysis. False-positive findings were defined as category 4 or 5 mammograms with a benign histologic diagnosis. False-negative findings were defined as a mammographic assessment 1, 2, or 3 with a cancer diagnosis at histologic examination within 1 year. A true-negative finding was interpreted as a category 1, 2, or 3 mammographic assessment with negative histologic diagnosis or normal mammogram within 1 year. The 95% CIs were determined by the normal approximation to the binomial distribution.






    RESULTS

    Prospective assessments of the 214 screening mammograms yielded the following findings: negative in 175 (81.8%); benign in 16 (7.5%); probably benign in 16 (7.5%); suspicious in six (2.8%); and highly suggestive of malignancy in one (0.5%).

    Of six patients who underwent biopsy for BI-RADS category 4 or 5 lesions, two (33%) had invasive ductal carcinoma at histologic examination (Figs 1, 2). Benign histologic findings in four (67%) of the six patients who underwent biopsy included two epidermoid inclusion cysts, one case of fat necrosis, and one case of fibrocystic change with calcifications (Fig 3). Biopsy was not performed in one patient with suspicious microcalcifications on mammograms because she was found to have metastatic disease.





    Figure 1a.(a) Craniocaudal (left) and mediolateral oblique (right) views of a TRAM-reconstructed breast show a 1.3-cm mass (arrow) adjacent to the chest wall. (b) Spot compression view better demonstrates the irregular margins of the mass (M). Invasive ductal carcinoma was found at biopsy.



     





    Figure 1b.(a) Craniocaudal (left) and mediolateral oblique (right) views of a TRAM-reconstructed breast show a 1.3-cm mass (arrow) adjacent to the chest wall. (b) Spot compression view better demonstrates the irregular margins of the mass (M). Invasive ductal carcinoma was found at biopsy.



     





    Figure 2. Magnification mediolateral oblique view of the upper outer quadrant of a TRAM-reconstructed breast shows a mass (arrows) with spiculated margins proved to represent recurrence of invasive ductal carcinoma. Adjacent mass (arrowheads) with calcifications was an area of fat necrosis.



     





    Figure 3a.(a) Native breast (left) and postmastectomy TRAM reconstruction (right) in the same patient. Mediolateral oblique view shows clustered calcifications with density (arrow) in the extreme upper outer quadrant of the TRAM-reconstructed breast. (b) Wire localization radiograph of the specimen better demonstrates the calcifications (arrows). Fibrocystic change with calcifications was found at histologic examination. This likely occurred in an area of native breast tissue not removed at mastectomy.



     





    Figure 3b.(a) Native breast (left) and postmastectomy TRAM reconstruction (right) in the same patient. Mediolateral oblique view shows clustered calcifications with density (arrow) in the extreme upper outer quadrant of the TRAM-reconstructed breast. (b) Wire localization radiograph of the specimen better demonstrates the calcifications (arrows). Fibrocystic change with calcifications was found at histologic examination. This likely occurred in an area of native breast tissue not removed at mastectomy.



     


    Follow-up mammographic and clinical information at 1 year or more was available for 171 (90%) of 191 mammographic examinations determined to be BI-RADS category 1 or 2 during the study period. In two (1.2%) of these 171 cases, carcinoma later developed in the TRAM-reconstructed breast: One was a nonpalpable mammographic finding at screening, and the other was a palpable and mammographic finding 2.5 years after a negative mammogram (this patient had no record of subsequent screening mammography). One additional patient developed palpable axillary recurrence at 1.5 years. There were no palpable interval cancers in the TRAM-reconstructed breast in the year following a BI-RADS category 1 or 2 assessment.

    Follow-up information was available for all 16 BI-RADS category 3 mammograms for a median time of 24 months (range, 12–36 months). Thirteen (81%) of these 16 cases were stable at mammographic follow-up and considered benign. In the other three cases (19%), the patient underwent biopsy. One patient had invasive ductal ductal cancer (1.2 cm) discovered at 6 months, and two patients had benign biopsy results.

    The mammographic cancer detection rate for the 106 patients with prior cancer as the reason for mastectomy and TRAM reconstruction was 1.9% (two of 106 patients) (95% CI: 0.33%, 7.32%) during the 2-year study period. One additional cancer was later found in a patient with a BI-RADS category 3 finding at follow-up and was considered a false-negative mammographic finding. The positive predictive value for cancer detection for mammographic lesions recommended for biopsy was 33% (95% CI: 6%, 76%). By excluding the 20 BI-RADS category 1 or 2 examinations without documented follow-up and the single category 4 examination without biopsy, there were two true-positive findings, four false-positive findings, one false-negative finding, and 186 true-negative findings. Therefore, sensitivity was 67% and specificity was 98%.

    Mammographic features in the two patients who underwent biopsy and in whom carcinoma was diagnosed during the study period were one mass with irregular margins adjacent to the pectoral muscle and one mass with spiculated margins in the extreme upper outer quadrant of the breast (Figs 1, 2). Both patients had an initial histologic diagnosis of ductal carcinoma in situ (DCIS) in association with invasive ductal carcinoma. Mammographic appearance of the BI-RADS category 3 tumor was focal asymmetric density on the first mammogram. The initial histologic diagnosis was invasive ductal cancer. Two of the three patients underwent immediate reconstruction at the time of original mastectomy. All patients were treated with lumpectomy and radiation therapy after discovery of the recurrence. Size of the recurrent invasive cancers at pathologic examination was 12–13 mm (mean, 12.7 mm). The time from the original diagnosis of cancer to diagnosis of TRAM recurrence was 6–10 years (mean, 7.3 years). Owing to the long duration from original diagnosis, these cancers could represent second primaries or recurrences.

    Additional mammographic views were required for 36 (17%) of the 214 examinations. US was used for four examinations (2%). All four US examinations revealed solid masses (three benign, one malignant) for which biopsy was performed. Five of six biopsies were performed by means of image-directed needle biopsy and the remaining one, by means of wire localization. In the craniocaudal view, mean technical factors were 27 kVp, 156 mAs, and 6.3-cm compressed breast thickness. The mean posterior nipple line length on the craniocaudal view was 7.7 cm.

    Initial histologic findings at mastectomy for 109 breasts with cancer (106 patients) were as follows: DCIS in 25 (23%); DCIS and invasive ductal in 40 (37%); invasive ductal in 16 (15%); invasive lobular in 10 (9%); and other cancer in 18 (17%).





    DISCUSSION

    Mastectomy followed by breast reconstruction is an accepted practice in women with breast cancer who are not eligible for BCT or in those who desire mastectomy. In cancer patients, prosthetic implant reconstruction or autologous reconstruction does not adversely affect survival (7–9). Furthermore, early breast reconstruction may improve the patient’s psychologic well-being (17).

    Although mastectomy is generally believed to be a definitive procedure, local recurrence in the chest wall or in the reconstructed breast does infrequently occur (2–10,18). Chest-wall recurrence after mastectomy is reported in 0.2%–1% of women per year (11). Recurrent local disease following mastectomy and reconstruction is similar to local recurrence following mastectomy alone. Singletary (6) reported a 4.2% recurrence rate in 95 patients with TRAM reconstructions who were followed up for more than 4 years. Kroll et al (9) noted a 6.7% TRAM recurrence rate at 5.6 years in 104 patients treated with skin-sparing mastectomy and reconstruction. Noone et al (7) reported a 6.7% TRAM recurrence rate at 6.4 years, and Johnson et al (8) reported a 6% local recurrence rate in 118 women with reconstructions (primarily implants) at 2.3 years. Slavin et al (10) reported an 11.7% recurrence rate at 5.4 years in 120 patients treated with TRAM or latissimi dorsi reconstructions, but 12% of the population included patients with stage 3 or 4 lesions. Overall, an annual recurrence rate of 1%–2% has been reported for T1 and T2 tumors during the first 5 years.

    Routine mammographic imaging is technically limited in those patients who have undergone reconstruction with prosthetic implants and has not generally been advocated. The situation with TRAM reconstructions is different. Because abdominal adipose tissue forms the bulk of the TRAM reconstruction, mammography of the TRAM flap is technically feasible (5,6,19–21). Opinions differ regarding the need for mammography in these women (5,6,9,19–21). This practice standard is different than the recommendation for women undergoing BCT, in whom routine mammography of the treated breast is advocated and widely practiced (22). The local recurrence rate in women undergoing BCT with lumpectomy and radiation therapy is 1%–2% per year (14), similar to the recurrence rate following TRAM reconstruction (6,7,9,10).

    On the basis of small series in which the mammographic appearance of recurrent carcinoma in TRAM flaps and imaging findings in TRAM reconstructions (5,12,16,19–21) were described, physicians in our breast cancer center became convinced that early mammographic detection of cancer recurrence in TRAM flap reconstructions was technically possible. The potential benefit of screening TRAM reconstructions would be the detection of recurrences at a smaller size than appreciated clinically. Early detection of recurrent disease would likely be most beneficial to women with early stage carcinoma without evidence of metastatic disease. Potential problems from screening TRAM reconstructions include the generation of false-positive assessments, a low biopsy positive predictive value, and the unproved benefit of early detection of recurrence.

    In breasts reconstructed with the TRAM flap technique, we found that screening mammography indeed enables detection of nonpalpable recurrences before clinical detection. The mammographic cancer detection rate was 1.9% (two of 106 patients) (95% CI: 0.33%, 7.32%) during the 2-year study period. The overall cancer recurrence rate (includes single false-negative category 3 lesion) was 2.8% (three of 106 patients). These rates are similar to the palpable 1% annual recurrence rate previously reported in patients with reconstructions (6,9,10) whose recurrence was detected at clinical examination. Of note, all recurrences in our study were discovered more than 5 years after mastectomy, which shows that recurrence continues to be a problem even after this interval.

    One-third of mammographic abnormalities for which biopsy was performed in our series were shown to represent carcinoma. Our series is too small and CIs too great to determine if this positive predictive value will be similar to that of routine screening mammography and consistent with that of clinical practice guidelines (23). False-positive mammographic findings occurred. Benign epidermoid inclusion cysts, which can manifest as growing masses that arise as a consequence of the TRAM operation, were the most common false-positive findings. Although fat necrosis may occur in 2%–13% of TRAM-reconstructed breasts (13), fat necrosis necessitating biopsy was unusual, occurring in one of 214 examinations. A single false-negative mammographic finding (category 3) occurred during a first mammographic examination. A larger series will be needed to more accurately determine the true false-negative rate and positive predictive value.

    Extensive DCIS and invasive cancer were present in the original malignancy in two of three patients with recurrence. A high frequency of extensive DCIS as the original malignancy was also found in a previous study of TRAM recurrence (5). Extensive DCIS may be associated with higher risk owing to the extensive geographic location of the disease. Women with extensive DCIS are generally not eligible for breast conservation and form a disproportionately high percentage of patients undergoing mastectomy. Most patients (59%) in our study had DCIS with or without invasive cancer. Hence, case selection bias would predict that most recurrences would also be in this group.

    Although screening the TRAM-reconstructed breast can help detect nonpalpable carcinoma, early detection of TRAM recurrence may or may not be associated with improved survival. TRAM recurrence in patients with invasive carcinoma may merely be a manifestation of systemic disease and aggressive tumor biology. Early detection of in-breast recurrence in patients treated with BCT is associated with longer survival, but lead-time bias may explain this finding (24). Early in-TRAM recurrence detection would be most important in patients with DCIS alone (no invasive cancer) and in those without metastatic disease. Even if survival is not affected, morbidity may be improved as diagnosis of early in-breast recurrence may allow for better local control. All patients in our series were treated with lumpectomy and radiation therapy. Clinical standards of care in the United States include aggressive surveillance with mammography and physical examination for patients treated with BCT. It may be reasonable to apply the same practice standards to women treated with TRAM reconstruction.

    Why breast cancer recurs in TRAM flaps has important biologic ramifications for understanding tumor behavior. Postulated mechanisms include residual cancer tissue, tumor seeding at time of mastectomy, sequestration of tumor cells within lymphatics, and unspecified host factors. Late “recurrence” could also be a new primary tumor that arises from benign breast tissue left after mastectomy. Mastectomy removes most (>95%) breast cells at risk but does not remove all breast cells at risk (21). This is well demonstrated in Figure 3, the case of a patient with extreme upper outer quadrant calcifications that were identified as fibrocystic change with calcifications at biopsy. In this patient, these fibrocystic changes were likely in breast tissue not excised at the time of mastectomy.

    Should routine screening of TRAM flaps be advocated for all patients? Our series is too small to make a definitive recommendation, but our findings provide inferential support of the practice. We continue to perform mammography in patients with TRAM reconstructions for cancer. Cancer occurrence in women treated with prophylactic mastectomy and TRAM reconstruction was not found. Because a small amount of residual breast tissue persists after prophylactic mastectomy, a small risk for cancer exists (25). The decision to mammographically screen this group of patients is best made following a balanced discussion between the patient and her physician.


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  • Nichola
    Nichola Member Posts: 402
    edited September 2013

    Hi DanaGirl

    I was already familiar with that article, but this is how I read it:  The figures are that only 1% of people who have reconstructions get a recurrence.  These are more likely in people who have "skin sparing" LD flap or tram flap reconstructions as there is always tiny bit of breast tissue left in the skin.  "Free" tram flap abdominal reconstructions use the fat AND skin from your abdomen and to summarise, only 4% (trams) of that 1% with reconstructions get a recurrence..., however, so that is REALLY rare.

    Having been in that overall 1% and again in the 4% of the 1%, I am and feel that it is always prudent to keep and eye on any changes around any reconstruction area.  If it is still there after a few weeks and bothers you, best to ask for an ultrasound to put your mind at rest?  I have aches and pains and proper hard lumps under my arm that feel like nodes, but I had an ultrasound that showed scar tissue.  When I had the recurrence after my second recon (Free Tram) - I notice the skin under my arm was puckering and I could feel a nodule... My onco surgeon  thought it all looked fine, but I had a gut feeling and....

    Hope this helps?

    N x




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  • Beesie
    Beesie Member Posts: 12,240
    edited September 2013

    Nichola, could you explain where your "4% of the 1%" comes from?  I missing that one.

    As I read this study, it says that while "(a)nnual local recurrence rates following mastectomy without reconstruction range from 0.2% to 1%", for those who have TRAM reconstruction, "4%–11% of patients (develop) recurrence in the TRAM-reconstructed breast, most within the first 5 years."

    As for the overall local recurrence rate after a MX, the following report pegs it at 2.4% at 10 years for those who are early stage and node-negative.  This figure represents an average that blends together all types of MXs, with or without reconstruction and including all types of reconstruction.  So both the TRAM numbers (4% - 11%) and the without reconstruction numbers (0.2% - 1%) would be included as part of this average. 

    Is Postmastectomy Radiation Necessary for All Breast Cancer Patients?  See the table about 3/4s of the way down the page.

    Just trying to understand what the real numbers and risk is here....

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  • Nichola
    Nichola Member Posts: 402
    edited September 2013

    Hi Dana

    As I understand it from this and other studies I have read in the past, recurrence in a reconstructed breast is 2 or 3% over 5 years and about 1% annually.   This particular article says 4 - 11% of those recurrent....

    ..."breast cancer following reconstruction, although uncommon, has been reported (2–10), with 4%–11% of patients developing recurrence in the TRAM-reconstructed breast, most within the first 5 years. Annual incidence of 1% has been reported (9)."

    Hope this clarifies...

    Nikki

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  • TwoHobbies
    TwoHobbies Member Posts: 2,118
    edited September 2013

    Dana I just wanted to add to what Nichola said. Especially if you had nodes removed the first time the lymph may travel up to the collarbone area rather than the armpit I had a recurrence in the skin and my new sentinel node was slightly under the collarbone. Now lymph nodes can get sore and tender without breast cancer but one surgeon told me if it's tender or enlarged for three weeks you should have it checked. It doesn't matter what the percentages are if you are the 1%. So if something troubles you get it checked.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited September 2013

    Thank you for all the information, ladies.  I'm just wondering if the tenderness and soreness are actually lymph nodes.

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