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Mammographic Surveillance after Breast Reconstruction-is Imaging Necessary?

Meredith I, Goh J and Gerred S

Background: There is no consensus in regards to surveillance of women after mastectomy and reconstruction for breast cancer. Mammographic detection rates are low for surveillance after reconstruction and whilst there is insufficient evidence to support annual mammography in these women, there is widespread variation in its use. We aimed to investigate the mode of detection of recurrent disease and comment on the use of surveillance mammography in our population of women undergoing mastectomy and reconstruction.

Method: Data were retrieved from the Auckland Breast Cancer Registry (ABCR). All women with recurrence after mastectomy and reconstruction between 2000 and 2013 were identified from the database. Clinical records were reviewed for type of reconstruction, site of recurrence and mode of detection.

Results: 1565 women underwent mastectomy and reconstruction. There were 54 women (3.4%) with locoregional recurrence (LRR) and 134 with distant disease (8.5%). Of all women with LRR, 51 women (94%) presented with a palpable mass. The remaining 3 women had their recurrence detected on mammography and had DCIS in their original histology. Only 16 of the 54 women had at least one surveillance mammogram. 12 of 16 women had a normal mammogram less than 9 months prior to diagnosis of recurrent disease.

Conclusion: Regular mammographic surveillance after mastectomy and reconstruction was not performed in this group, and therefore we cannot evaluate the value of regular mammographic surveillance after mastectomy and reconstruction. However, in light of the existing body of literature, there is no evidence to support regular mammographic surveillance after mastectomy and reconstruction.