Surveillance Imaging in Breast Cancer Patients Undergoing Breast Conserving Surgery With Chest Wall Perforator Flap Reconstruction

Background and purpose: Problem Statement. Breast conserving surgery (BCS) using chest wall perforator flaps (CWPFs) have increased in popularity over the past decade. There is paucity in literature regarding CWPF and its implication on breast cancer surveillance imaging. This study aims to answer that question. Method: This is a retrospective analysis of consecutive patients who underwent either BCS with CWPF or BCS only between August 2020 and April 2023 by breast oncoplastic surgeons in a tertiary referral centre. Qualitative analysis of postoperative mammogram and ultrasound were performed. Results: Twenty patients undergoing CWPF were compared to twenty patients undergoing BCS only with median follow up of 1.4 years. The CWPF group was younger and had larger tumour size. Tumour pathological characteristics were similar in both groups. Both groups had similar incidence of benign reported features on imaging, which include benign calcifications, fat necrosis, volume loss, and radiotherapy changes. There was no significant difference in the diagnostic biopsy between the two groups. Only two patients in the CWPF group were recalled. They underwent biopsies which showed post-surgical changes and a benign cyst respectively. Conclusion: Patients who had BCS with CWPF did not have greater rates of imaging abnormality comparted to patient who had BCS only. We conclude that CWPF did not lead to greater rates of diagnostic procedures and dilemma during the surveillance period. As our surveillance period is relatively short, further studies with longer follow-up will be required. References: 1. Hu J, Cuffolo G, Parulekar V, Chan V, Tenovici A, Roy PG. The Results of Surveillance Imaging After Breast Conservation Surgery and Partial Breast Reconstruction With Chest Wall Perforator Flaps; A Qualitative Analysis Compared With Standard Breast-Conserving Surgery for Breast Cancer. Clin Breast Cancer. 2019 Jun;19(3):e422-e427. doi: 10.1016/j.clbc.2019.01.010. Epub 2019 Jan 31. PMID: 30797681. 2. Schaverien MV, Kuerer HM, Caudle AS, Smith BD, Hwang RF, Robb GL. Outcomes of Volume Replacement Oncoplastic Breast-Conserving Surgery Using Chest Wall Perforator Flaps: Comparison with Volume Displacement Oncoplastic Surgery and Total Breast Reconstruction. Plast Reconstr Surg. 2020 Jul;146(1):14-27. doi: 10.1097/PRS.0000000000006911. PMID: 32590634.