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Management of locoregional recurrence of breast cancer after mastectomy

Ariel Hirsch, MD
Michael S Sabel, MD
Daniel F Hayes, MD
Section Editor
Harold Burstein, MD, PhD
Deputy Editor
Wenliang Chen, MD, PhD


Following mastectomy for operable breast cancer, disease can recur locally, regionally, and/or at distant metastatic sites. A local recurrence is defined as reappearance of cancer on the ipsilateral chest wall. In contrast, a regional recurrence denotes tumor involving the regional lymph nodes, usually ipsilateral axillary or supraclavicular, less commonly infraclavicular and/or internal mammary nodes.

Treatment has the potential to provide long-term disease control for patients who develop an isolated locoregional recurrence after mastectomy. However, the management of these patients is complex and usually requires multidisciplinary assessment and planning.

The management of a locoregional recurrence after mastectomy for operable breast cancer will be reviewed here. The management of a local recurrence after breast-conserving therapy (BCT) is discussed elsewhere. (See "Management of locoregional recurrence of breast cancer after breast conserving therapy".)


Approximately 5 to 10 percent of patients undergoing mastectomy for operable breast cancer will have a chest wall or regional nodal recurrence within 10 years [1-7]. The risk of a postmastectomy locoregional recurrence is slightly lower than that after breast-conserving therapy (BCT, 10 to 15 percent), although it is much higher in women who undergo breast-conserving surgery without radiation therapy (RT). (See "Adjuvant radiation therapy for women with newly diagnosed, non-metastatic breast cancer".)

There are also differences in the time course, clinical features, and prognosis of a locoregional recurrence after mastectomy as compared with BCT:


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Literature review current through: Sep 2016. | This topic last updated: Oct 18, 2016.
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  1. van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 2000; 92:1143.
  2. Jacobson JA, Danforth DN, Cowan KH, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 1995; 332:907.
  3. Arriagada R, Lê MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 1996; 14:1558.
  4. Stefanik D, Goldberg R, Byrne P, et al. Local-regional failure in patients treated with adjuvant chemotherapy for breast cancer. J Clin Oncol 1985; 3:660.
  5. Schmoor C, Sauerbrei W, Bastert G, Schumacher M. Role of isolated locoregional recurrence of breast cancer: results of four prospective studies. J Clin Oncol 2000; 18:1696.
  6. Buchanan CL, Dorn PL, Fey J, et al. Locoregional recurrence after mastectomy: incidence and outcomes. J Am Coll Surg 2006; 203:469.
  7. Jatoi I, Tsimelzon A, Weiss H, et al. Hazard rates of recurrence following diagnosis of primary breast cancer. Breast Cancer Res Treat 2005; 89:173.
  8. van Tienhoven G, Voogd AC, Peterse JL, et al. Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Eur J Cancer 1999; 35:32.
  9. Francis M, Cakir B, Ung O, et al. Prognosis after breast recurrence following conservative surgery and radiotherapy in patients with node-negative breast cancer. Br J Surg 1999; 86:1556.
  10. Dalberg K, Mattsson A, Sandelin K, Rutqvist LE. Outcome of treatment for ipsilateral breast tumor recurrence in early-stage breast cancer. Breast Cancer Res Treat 1998; 49:69.
  11. Katz A, Strom EA, Buchholz TA, et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol 2000; 18:2817.
  12. Danish Breast Cancer Cooperative Group, Nielsen HM, Overgaard M, et al. Study of failure pattern among high-risk breast cancer patients with or without postmastectomy radiotherapy in addition to adjuvant systemic therapy: long-term results from the Danish Breast Cancer Cooperative Group DBCG 82 b and c randomized studies. J Clin Oncol 2006; 24:2268.
  13. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997; 337:949.
  14. Freedman GM, Fowble BL. Local recurrence after mastectomy or breast-conserving surgery and radiation. Oncology (Williston Park) 2000; 14:1561.
  15. Pisansky TM, Ingle JN, Schaid DJ, et al. Patterns of tumor relapse following mastectomy and adjuvant systemic therapy in patients with axillary lymph node-positive breast cancer. Impact of clinical, histopathologic, and flow cytometric factors. Cancer 1993; 72:1247.
  16. Recht A, Gray R, Davidson NE, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol 1999; 17:1689.
  17. Willner J, Kiricuta IC, Kölbl O. Locoregional recurrence of breast cancer following mastectomy: always a fatal event? Results of univariate and multivariate analysis. Int J Radiat Oncol Biol Phys 1997; 37:853.
  18. Ballo MT, Strom EA, Prost H, et al. Local-regional control of recurrent breast carcinoma after mastectomy: does hyperfractionated accelerated radiotherapy improve local control? Int J Radiat Oncol Biol Phys 1999; 44:105.
  19. Haylock BJ, Coppin CM, Jackson J, et al. Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy. Int J Radiat Oncol Biol Phys 2000; 46:355.
  20. Schwaibold F, Fowble BL, Solin LJ, et al. The results of radiation therapy for isolated local regional recurrence after mastectomy. Int J Radiat Oncol Biol Phys 1991; 21:299.
  21. Hsi RA, Antell A, Schultz DJ, Solin LJ. Radiation therapy for chest wall recurrence of breast cancer after mastectomy in a favorable subgroup of patients. Int J Radiat Oncol Biol Phys 1998; 42:495.
  22. Nielsen HM, Overgaard M, Grau C, et al. Loco-regional recurrence after mastectomy in high-risk breast cancer--risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials. Radiother Oncol 2006; 79:147.
  23. Cheng SH, Horng CF, Clarke JL, et al. Prognostic index score and clinical prediction model of local regional recurrence after mastectomy in breast cancer patients. Int J Radiat Oncol Biol Phys 2006; 64:1401.
  24. Ragaz J, Jackson SM, Le N, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 1997; 337:956.
  25. EBCTCG (Early Breast Cancer Trialists' Collaborative Group), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 2014; 383:2127.
  26. Recht A, Comen EA, Fine RE, et al. Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. Pract Radiat Oncol 2016.
  27. Kuo SH, Huang CS, Kuo WH, et al. Comprehensive locoregional treatment and systemic therapy for postmastectomy isolated locoregional recurrence. Int J Radiat Oncol Biol Phys 2008; 72:1456.
  28. Leibman AJ, Styblo TM, Bostwick J 3rd. Mammography of the postreconstruction breast. Plast Reconstr Surg 1997; 99:698.
  29. Loyer EM, Kroll SS, David CL, et al. Mammographic and CT findings after breast reconstruction with a rectus abdominis musculocutaneous flap. AJR Am J Roentgenol 1991; 156:1159.
  30. Eidelman Y, Liebling RW, Buchbinder S, et al. Mammography in the evaluation of masses in breasts reconstructed with TRAM flaps. Ann Plast Surg 1998; 41:229.
  31. Kim SM, Park JM. Mammographic and ultrasonographic features after autogenous myocutaneous flap reconstruction mammoplasty. J Ultrasound Med 2004; 23:275.
  32. Devon RK, Rosen MA, Mies C, Orel SG. Breast reconstruction with a transverse rectus abdominis myocutaneous flap: spectrum of normal and abnormal MR imaging findings. Radiographics 2004; 24:1287.
  33. Helvie MA, Bailey JE, Roubidoux MA, et al. Mammographic screening of TRAM flap breast reconstructions for detection of nonpalpable recurrent cancer. Radiology 2002; 224:211.
  34. Helvie MA, Wilson TE, Roubidoux MA, et al. Mammographic appearance of recurrent breast carcinoma in six patients with TRAM flap breast reconstructions. Radiology 1998; 209:711.
  35. Edeiken BS, Fornage BD, Bedi DG, et al. Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis. Radiology 2003; 227:542.
  36. Salas AP, Helvie MA, Wilkins EG, et al. Is mammography useful in screening for local recurrences in patients with TRAM flap breast reconstruction after mastectomy for multifocal DCIS? Ann Surg Oncol 1998; 5:456.
  37. McCarthy CM, Pusic AL, Sclafani L, et al. Breast cancer recurrence following prosthetic, postmastectomy reconstruction: incidence, detection, and treatment. Plast Reconstr Surg 2008; 121:381.
  38. Barnsley GP, Grunfeld E, Coyle D, Paszat L. Surveillance mammography following the treatment of primary breast cancer with breast reconstruction: a systematic review. Plast Reconstr Surg 2007; 120:1125.
  39. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), Breast Cancer (version 1.2014). http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (Accessed on January 28, 2014).
  40. Scatarige JC, Fishman EK, Zinreich ES, et al. Internal mammary lymphadenopathy in breast carcinoma: CT appraisal of anatomic distribution. Radiology 1988; 167:89.
  41. Lindfors KK, Meyer JE, Busse PM, et al. CT evaluation of local and regional breast cancer recurrence. AJR Am J Roentgenol 1985; 145:833.
  42. Rosenman J, Churchill CA, Mauro MA, et al. The role of computed tomography in the evaluation of post-mastectomy locally recurrent breast cancer. Int J Radiat Oncol Biol Phys 1988; 14:57.
  43. Lingawi SS, Bilbey JH, Munk PL, et al. MR imaging of brachial plexopathy in breast cancer patients without palpable recurrence. Skeletal Radiol 1999; 28:318.
  44. Radan L, Ben-Haim S, Bar-Shalom R, et al. The role of FDG-PET/CT in suspected recurrence of breast cancer. Cancer 2006; 107:2545.
  45. Eubank WB, Mankoff D, Bhattacharya M, et al. Impact of FDG PET on defining the extent of disease and on the treatment of patients with recurrent or metastatic breast cancer. AJR Am J Roentgenol 2004; 183:479.
  46. Gallowitsch HJ, Kresnik E, Gasser J, et al. F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging. Invest Radiol 2003; 38:250.
  47. Eubank WB, Mankoff DA, Takasugi J, et al. 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J Clin Oncol 2001; 19:3516.
  48. Bender H, Kirst J, Palmedo H, et al. Value of 18fluoro-deoxyglucose positron emission tomography in the staging of recurrent breast carcinoma. Anticancer Res 1997; 17:1687.
  49. Isasi CR, Moadel RM, Blaufox MD. A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases. Breast Cancer Res Treat 2005; 90:105.
  50. Wahl AO, Rademaker A, Kiel KD, et al. Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer. Int J Radiat Oncol Biol Phys 2008; 70:477.
  51. Eubank WB. Diagnosis of recurrent and metastatic disease using f-18 fluorodeoxyglucose-positron emission tomography in breast cancer. Radiol Clin North Am 2007; 45:659.
  52. Aberizk WJ, Silver B, Henderson IC, et al. The use of radiotherapy for treatment of isolated locoregional recurrence of breast carcinoma after mastectomy. Cancer 1986; 58:1214.
  53. Borner M, Bacchi M, Goldhirsch A, et al. First isolated locoregional recurrence following mastectomy for breast cancer: results of a phase III multicenter study comparing systemic treatment with observation after excision and radiation. Swiss Group for Clinical Cancer Research. J Clin Oncol 1994; 12:2071.
  54. Halverson KJ, Perez CA, Kuske RR, et al. Survival following locoregional recurrence of breast cancer: univariate and multivariate analysis. Int J Radiat Oncol Biol Phys 1992; 23:285.
  55. Andry G, Suciu S, Vico P, et al. Locoregional recurrences after 649 modified radical mastectomies: incidence and significance. Eur J Surg Oncol 1989; 15:476.
  56. Chagpar A, Kuerer HM, Hunt KK, et al. Outcome of treatment for breast cancer patients with chest wall recurrence according to initial stage: implications for post-mastectomy radiation therapy. Int J Radiat Oncol Biol Phys 2003; 57:128.
  57. Halverson KJ, Perez CA, Kuske RR, et al. Isolated local-regional recurrence of breast cancer following mastectomy: radiotherapeutic management. Int J Radiat Oncol Biol Phys 1990; 19:851.
  58. Faneyte IF, Rutgers EJ, Zoetmulder FA. Chest wall resection in the treatment of locally recurrent breast carcinoma: indications and outcome for 44 patients. Cancer 1997; 80:886.
  59. Pfannschmidt J, Geisbüsch P, Muley T, et al. Surgical resection of secondary chest wall tumors. Thorac Cardiovasc Surg 2005; 53:234.
  60. Kroll SS, Schusterman MA, Larson DL, Fender A. Long-term survival after chest-wall reconstruction with musculocutaneous flaps. Plast Reconstr Surg 1990; 86:697.
  61. Beck TM, Hart NE, Woodard DA, Smith CE. Local or regionally recurrent carcinoma of the breast: results of therapy in 121 patients. J Clin Oncol 1983; 1:400.
  62. Salvadori B, Rovini D, Squicciarini P, et al. Surgery for local recurrences following deficient radical mastectomy for breast cancer: a selected series of 39 cases. Eur J Surg Oncol 1992; 18:438.
  63. McCormack PM, Bains MS, Burt ME, et al. Local recurrent mammary carcinoma failing multimodality therapy. A solution. Arch Surg 1989; 124:158.
  64. Toi M, Tanaka S, Bando M, et al. Outcome of surgical resection for chest wall recurrence in breast cancer patients. J Surg Oncol 1997; 64:23.
  65. Flook D, Webster DJ, Hughes LE, Mansel RW. Salvage surgery for advanced local recurrence of breast cancer. Br J Surg 1989; 76:512.
  66. Dahlstrøm KK, Andersson AP, Andersen M, Krag C. Wide local excision of recurrent breast cancer in the thoracic wall. Cancer 1993; 72:774.
  67. Miyauchi K, Koyama H, Noguchi S, et al. Surgical treatment for chest wall recurrence of breast cancer. Eur J Cancer 1992; 28A:1059.
  68. Friedel G, Kuipers T, Dippon J, et al. Full-thickness resection with myocutaneous flap reconstruction for locally recurrent breast cancer. Ann Thorac Surg 2008; 85:1894.
  69. Karam A, Stempel M, Cody HS 3rd, Port ER. Reoperative sentinel lymph node biopsy after previous mastectomy. J Am Coll Surg 2008; 207:543.
  70. Deutsch M, Parsons JA, Mittal BB. Radiation therapy for local-regional recurrent breast carcinoma. Int J Radiat Oncol Biol Phys 1986; 12:2061.
  71. Mendenhall NP, Devine JW, Mendenhall WM, et al. Isolated local-regional recurrence following mastectomy for adenocarcinoma of the breast treated with radiation therapy alone or combined with surgery and/or chemotherapy. Radiother Oncol 1988; 12:177.
  72. Haffty BG, Hauser A, Choi DH, et al. Molecular markers for prognosis after isolated postmastectomy chest wall recurrence. Cancer 2004; 100:252.
  73. Chen KK, Montague ED, Oswald MJ. Results of irradiation in the treatment of locoregional breast cancer recurrence. Cancer 1985; 56:1269.
  74. Elkort RJ, Kelly W, Mozden PJ, Feldman MI. A combined treatment program for the management of locally recurrent breast cancer following chest wall irradiation. Cancer 1980; 46:647.
  75. Vernon CC, Hand JW, Field SB, et al. Radiotherapy with or without hyperthermia in the treatment of superficial localized breast cancer: results from five randomized controlled trials. International Collaborative Hyperthermia Group. Int J Radiat Oncol Biol Phys 1996; 35:731.
  76. Welz S, Hehr T, Lamprecht U, et al. Thermoradiotherapy of the chest wall in locally advanced or recurrent breast cancer with marginal resection. Int J Hyperthermia 2005; 21:159.
  77. Li G, Mitsumori M, Ogura M, et al. Local hyperthermia combined with external irradiation for regional recurrent breast carcinoma. Int J Clin Oncol 2004; 9:179.
  78. Lee HK, Antell AG, Perez CA, et al. Superficial hyperthermia and irradiation for recurrent breast carcinoma of the chest wall: prognostic factors in 196 tumors. Int J Radiat Oncol Biol Phys 1998; 40:365.
  79. Kapp DS, Cox RS. Thermal treatment parameters are most predictive of outcome in patients with single tumor nodules per treatment field in recurrent adenocarcinoma of the breast. Int J Radiat Oncol Biol Phys 1995; 33:887.
  80. Feyerabend T, Wiedemann GJ, Jäger B, et al. Local hyperthermia, radiation, and chemotherapy in recurrent breast cancer is feasible and effective except for inflammatory disease. Int J Radiat Oncol Biol Phys 2001; 49:1317.
  81. Schuh M, Nseyo UO, Potter WR, et al. Photodynamic therapy for palliation of locally recurrent breast carcinoma. J Clin Oncol 1987; 5:1766.
  82. Sperduto PW, DeLaney TF, Thomas G, et al. Photodynamic therapy for chest wall recurrence in breast cancer. Int J Radiat Oncol Biol Phys 1991; 21:441.
  83. Khan SA, Dougherty TJ, Mang TS. An evaluation of photodynamic therapy in the management of cutaneous metastases of breast cancer. Eur J Cancer 1993; 29A:1686.
  84. Mang TS, Allison R, Hewson G, et al. A phase II/III clinical study of tin ethyl etiopurpurin (Purlytin)-induced photodynamic therapy for the treatment of recurrent cutaneous metastatic breast cancer. Cancer J Sci Am 1998; 4:378.
  85. Wyss P, Schwarz V, Dobler-Girdziunaite D, et al. Photodynamic therapy of locoregional breast cancer recurrences using a chlorin-type photosensitizer. Int J Cancer 2001; 93:720.
  86. Lapes M, Petera J, Jirsa M. Photodynamic therapy of cutaneous metastases of breast cancer after local application of meso-tetra-(para-sulphophenyl)-porphin (TPPS4). J Photochem Photobiol B 1996; 36:205.
  87. Koren H, Alth G, Schenk GM, Jindra RH. Photodynamic therapy--an alternative pathway in the treatment of recurrent breast cancer. Int J Radiat Oncol Biol Phys 1994; 28:463.
  88. Allison R, Mang T, Hewson G, et al. Photodynamic therapy for chest wall progression from breast carcinoma is an underutilized treatment modality. Cancer 2001; 91:1.
  89. Halverson KJ, Perez CA, Kuske RR, et al. Locoregional recurrence of breast cancer: a retrospective comparison of irradiation alone versus irradiation and systemic therapy. Am J Clin Oncol 1992; 15:93.
  90. Recht A, Pierce SM, Abner A, et al. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1991; 9:988.
  91. Galper S, Blood E, Gelman R, et al. Prognosis after isolated axillary nodal recurrence following conservative surgery and radiotherapy for early-stage bareast carcinoma (abstract). Int J Radiat Oncol Biol Phys 2002; 54(2 suppl):56s.
  92. Fowble B, Solin LJ, Schultz DJ, Goodman RL. Frequency, sites of relapse, and outcome of regional node failures following conservative surgery and radiation for early breast cancer. Int J Radiat Oncol Biol Phys 1989; 17:703.
  93. Jagsi R. Breast cancer in the supraclavicular region: is the horse out of the barn? Breast Cancer Res Treat 2011; 125:823.
  94. Pergolizzi S, Adamo V, Russi E, et al. Prospective multicenter study of combined treatment with chemotherapy and radiotherapy in breast cancer women with the rare clinical scenario of ipsilateral supraclavicular node recurrence without distant metastases. Int J Radiat Oncol Biol Phys 2006; 65:25.
  95. van der Sangen MJ, Coebergh JW, Roumen RM, et al. Detection, treatment, and outcome of isolated supraclavicular recurrence in 42 patients with invasive breast carcinoma. Cancer 2003; 98:11.
  96. Ampil FL, Caldito G, Li BD, Burton GV. Supraclavicular nodal relapse of breast cancer: prevalence, palliation, and prognosis. Eur J Gynaecol Oncol 2003; 24:233.
  97. Kiricuta IC, Willner J, Kölbl O, Bohndorf W. The prognostic significance of the supraclavicular lymph node metastases in breast cancer patients. Int J Radiat Oncol Biol Phys 1994; 28:387.
  98. Chen SC, Chang HK, Lin YC, et al. Prognosis of breast cancer after supraclavicular lymph node metastasis: not a distant metastasis. Ann Surg Oncol 2006; 13:1457.
  99. Pedersen AN, Møller S, Steffensen KD, et al. Supraclavicular recurrence after early breast cancer: a curable condition? Breast Cancer Res Treat 2011; 125:815.
  100. Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol 2006; 24:2028.
  101. Harris EE, Hwang WT, Seyednejad F, Solin LJ. Prognosis after regional lymph node recurrence in patients with stage I-II breast carcinoma treated with breast conservation therapy. Cancer 2003; 98:2144.
  102. Brito RA, Valero V, Buzdar AU, et al. Long-term results of combined-modality therapy for locally advanced breast cancer with ipsilateral supraclavicular metastases: The University of Texas M.D. Anderson Cancer Center experience. J Clin Oncol 2001; 19:628.
  103. Reddy JP, Levy L, Oh JL, et al. Long-term outcomes in patients with isolated supraclavicular nodal recurrence after mastectomy and doxorubicin-based chemotherapy for breast cancer. Int J Radiat Oncol Biol Phys 2011; 80:1453.