Benefit of mastectomy in the case of metastatic breast cancer is not well proven. Previous studies have contradicting results. The objective of this study is to audit regional breast unit outcomes on mastectomy for stage 4 breast cancer.
We included all patients with stage 4 breast cancer whom underwent mastectomy with or without flap reconstruction from Jan 2013 to June 2015. This study was conducted in Breast Surgery Unit, Hospital Sultan Ismail, Johor Bahru. Data including age, site of metastasis, and time interval from symptom onset to surgery, type of surgery, post-op complications, recurrence and mortality are traced from hospital records.
There are 26 female patients included with mean age of 51(28-73). Mean post-mastectomy follow up duration is 11.18 months (SD 10.04). Majority of them have lung (22%) and bone metastasis (22%). They had a late presentation with mean interval time from onset of symptoms to operation about 21.4 months (SD 24.7). Mastectomy with axillary clearance without flap closure was performed in 17 patients (63%), with local flap closure in 2 patients & LD (latissimus dorsi) flap closure in 5 patients. One patient each from local flap closure and LD flap closure has wound dehiscence. Those had mastectomy without flap closure, 2 patients developed seroma and 1 developed deep vein thrombosis. Majority of patients had received chemotherapy pre-operatively (22 patients, 81.5%). 6 patients developed local recurrence post operatively with mean time of 1.67months (SD 1.03). The 6 patients that had recurrence, 3 patients had LD flap reconstruction. Odds ratio of patients whom had underwent mastectomy with flap reconstruction for developing a local recurrence were OR 4.0, 95% CI (0.58 to 27.82).There were 2 mortalities with mean time of 7 months post operatively (SD 7.07). These two patients underwent mastectomy without a flap closure.
Mastectomy in stage 4 breast cancer has low morbidity and mortality but the recurrence rate is higher when flap closure is required.
Clinical trial identification
All authors have declared no conflicts of interest.