Mammographic appearance of recurrent breast carcinoma in six patients with TRAM flap breast reconstructions

PURPOSE: To determine the mammographic appearance of locally recurrent cancer in patients with breast reconstructions with transverse rectus abdominis musculocutaneous (TRAM) flaps after mastectomy for primary breast cancer. MATERIALS AND METHODS: The mammograms and records of women treated for breast cancer with mastectomy and TRAM flap reconstruction who developed local recurrences from 1995 to 1997 were reviewed retrospectively. Eight cancers were identified in six women. Five women had palpable abnormalities, and the sixth had cancer detected at screening mammography at another institution. Mean age at recurrence was 48 years. RESULTS: All eight cancers were visible on mammograms: four masses, two pleomorphic microcalcifications, and two masses with calcifications. Four of the eight were in the upper central portion of the breast. Before reconstruction, the original histologic diagnosis for all cases had been multifocal ductal carcinoma in situ. All recurrences were invasive cancer. Median time from the original diagnosis of breast cancer to diagnosis of recurrence was 42 months. Two of four patients who subsequently underwent axillary node dissection had metastatic disease in the lymph nodes. The single patient who underwent mammographic screening (elsewhere) had negative axillary lymph nodes. CONCLUSION: The mammographic appearance of recurrent carcinoma in TRAM flap reconstructions is similar to that of primary breast cancer.