Outcomes of ipsilateral breast tumor recurrence after breast conserving surgery: Repeat lumpectomy as an alternative to salvage mastectomy

Abstract

Background: We examined the outcomes of salvage mastectomy and repeat lumpectomy for management of ipsilateral breast tumor recurrence.

Methods: Between 2013 and 2019, 113 patients with an ipsilateral breast tumor recurrence after breast conserving surgery were identified. Patients and tumor characteristics at initial diagnosis and at recurrence were collected. Outcomes evaluated included second recurrence and overall survival. Complications at 30-days and 90-days after surgery for ipsilateral breast tumor recurrence were evaluated.

Results: Seventy-two percent of patients underwent salvage mastectomy (n = 84) and 28% underwent repeat lumpectomy (n = 32 overall, n = 13 reirradiation). Salvage mastectomy patients were younger at initial diagnosis (P = .007) with longer time to ipsilateral breast tumor recurrence from first diagnosis (P = .03). At 2.5 years median follow-up, the overall incidence of second recurrence was 8% with 5% rate (n = 4) in salvage mastectomy group versus 16% (n = 5) in repeat lumpectomy group; however, among patients undergoing repeat lumpectomy with reirradiation (n = 13), only one patient developed a second recurrence (8%). There was no significant difference in rates of second local recurrence (P = .11), disease free survival (P = .13), or overall survival (P = .95) between repeat lumpectomy with reirradiation and salvage mastectomy.

Conclusion: At a short-term follow-up, repeat lumpectomy with reirradiation could be considered in a select group of patients presenting with an ipsilateral breast tumor recurrence with multidisciplinary input with low rates of postoperative complications and equivalent survival outcomes.