Local recurrence of breast cancer in reconstructed breasts using TRAM flap after skin-sparing mastectomy: clinical and imaging features.

Objectives: To evaluate clinical and imaging features of cancer recurrence in reconstructed breasts following skin-sparing mastectomy (SSM) or nipple areolar skin-sparing mastectomy (NASSM).

Methods: This study was approved by our Institutional Review Board. In this retrospective study, we included patients with pathologically confirmed recurrent cancer who had transverse rectus abdominis myocutaneous (TRAM) flap reconstruction after SSM or NASSM and whose follow-up radiological studies were available. Each patient's demographic data, imaging studies and clinical outcomes were reviewed. Two breast radiologists analysed the imaging findings of follow-up mammography, ultrasound and magnetic resonance imaging.

Results: Of the 964 patients, 16 (1.7%) had local cancer recurrence. The average follow-up period until the detection was 31.1 months (range, 7-84 months). Fourteen (87.5%) patients had recurrence on the skin or in subcutaneous fat. Of the 16 patients, recurrence was detected by breast self-examination in 13 (81.3%) patients. Eight (50%) lesions mimicked benign lesions. The other eight (50%) lesions manifested various degree of suspicion for the malignancy.

Conclusions: Recurrent cancer after TRAM flap reconstruction following SSM and NASSM is often recognised by breast self-examination and mimics imaging findings of benign lesions. Therefore, meticulous physical examination and history-taking are important. Pathological confirmation is worthwhile even in the benign-appearing lesions.

Key Points: Overview of clinical and imaging features of cancer recurrence in reconstructed breasts. 50% of recurred malignant lesions mimicking imaging findings of benign lesions. Patients may benefit from thorough self-breast examination.