42 Chapter 3 followed by reconstruction, either with Tissue Expander (TE), permanent implants or transverse rectus abdominis muscle (TRAM) flap autologous reconstruction. The follow up time was at least five years.16 Salgarello et al reported the results of 220 patients receiving 256 mastectomies with PF preservation. All patients received an immediate one-stage reconstruction with a definitive prosthesis by using the PF to cover the prosthesis in the lower pole. Tumor types were either invasive breast cancer (n=234, 91.5%) or DCIS (n=22 (8.5%). The length of the follow-up was relatively short with a mean of 29 months (range 3 months – 5 years).13 Oncological outcomes In the RCT of Dalberg et al, chest wall recurrences occurred in 18 patients (14.6%) in the PF preservation group, compared to 10 patients (8.3%) in the PF removal group, which was not statistically significant (p=0.12). No significant difference (p=0.82) in regional recurrences was observed, with seven (5.7%) regional recurrences in the PF preservation group versus eight (6.6%) in the PF removal group. No difference (p=0.61) in the occurrence of distant metastasis was observed with 39 (31.7%) in the PF preservation group versus 35 (28.9%) of n=121 patients in in the PF removal group, and mortality rates were similar as well (43.1% versus 38.8% respectively, p=0,47, Table 2).15 There were no local recurrences in both groups in the RCT by Abdelhamid et al.10 In the retrospective study of Sandelin et al, locoregional recurrences were reported in 13 of 203 patients (6.4%), of which nine (4.4%) were chest wall recurrences, and 4 (2.0%) were regional recurrences. Distant metastases were reported in six patients (3%). Thirty-one patients (15.4%) died due to advanced breast cancer.16 Table 2. Oncological outcomes in the five included studies. Study Reference Local recurrence Regional recurrence PF preservation PF removal P-value PF preservation PF removal P-value Dalberg, 2004 n=16 (12.8%) n=8 (6.6%) P=0.09 n= 8 (6.4%) n= 8 (6.6%) p=0.99 Dalberg, 2010 n=18 (14.6%) n=10 (8.3%) P=0.12 n= 7 (5.7%) n= 8 (6.6%) P=0.82 Abdelhamid, 2017 n=0 (0.0%) n=0 (0.0%) P=1.0 - - - Sandelin, 2004 n=9 (4.4%) - - n=5 (2.5%) - Salgarello, 2011 N=2 (1.1%) - - - - - PF: pectoral fascia.
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