The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and Osteoradionecrosis

Abstract

Background: The effectiveness and safety of chest wall surgery for various breast conditions remain unclear. Previous studies have reported a high risk of morbidity. We hypothesized that the limited chest wall resection can be performed under safe and good technique and aim to identify the extent of safe surgery. Methods: A retrospective study analyzed patients who underwent chest wall resection for chest wall recurrence breast cancer, locally advanced breast cancer, phyllodes, fibromatosis breast tumor, and osteoradionecrosis from January 1, 2008, to April 10, 2023. The primary objectives were the extent of safe chest wall surgery and performance status postoperatively. Results: Thirteen chest wall resections with an average of two to three ribs removed were performed. Patients who had two or more rib resections underwent mesh stabilization; nevertheless, paradoxical chest without deteriorating oxygenation remained. Anterolateral thigh-free flap, pedicled-TRAM or latissimus dorsi flap, pectoralis major myocutaneous flap, and local fasciocutaneous bilateral advancement flap were performed on five, four, three, and one patient, respectively. Patients with a maximum of three ribs removed had an ECOG score of 0–1 postoperatively. Hematoma and wound dehiscence affected two patients. In a small series of chest wall recurrence cases (N  = 7), R0 resection had better disease-free survival of 13 months. Conclusions: The procedure of chest wall resection and reconstruction can be performed safely with a maximum of three ribs removed, using mesh and myocutaneous flaps in two or more rib resections. Further studies with larger sample sizes will provide better understanding.