Chest wall reconstruction after recurrent breast cancer using
the scapular flap
Christopher R. Davis
Simon J. Cawthorn
Received: 4 June 2013 /Accepted: 11 August 2013 /Published online: 6 September 2013
Springer-Verlag Berlin Heidelberg 2013
Background Breast cancer is a common female malignancy
with numerous reconstructive options following mastectomy.
However, in recurrent disease, few donor sites exist. The
scapular flap may reconstruct ablative defects after recurrence.
This paper describes its 5-year application.
Methods All patients with recurrent breast cancer necessitating
chest wall reconstruction with a scapular flap were included in
this 5-year study. Patients were prospectively followed up for
clinical, surgical and patient-reported outcome measures.
Results Eight patients underwent scapular flap chest wall
reconstruction for recurrent breast cancer. The majority of
tumours were invasive ductal carcinomas (n =5; 62.5 %).
Mean duration from primary breast cancer to scapular flap
reconstruction was 12 years (range 2–32 years). All flaps
survived, including patients who smoked and received adju-
vant radiotherapy. Donor site morbidity was minimal with full
ipsilateral limb functioning.
Conclusions Scapular flap reconstruction of the chest is a
safe, reliable and consistent technique in recurrent breast
Level of Evidence: Level IV, therapeutic study.
Keywords Breast cancer
Breast cancer is the most common female malignancy with an
incidence of over 40,000 cases per annum in the UK and
predicted to increase over the next 20 years . Forty percent of
breast cancer patients undergo mastectomy , following
which a variety of reconstructive options exist [3, 4].
However, despite optimal evidence-based combinations of sur-
gery, chemotherapy and radiotherapy, recurrent disease affects
up to 20–30 % of patients [5, 6]. For patients with local
recurrence, if response to systemic chemotherapy is good and
local disease impacts on quality of life, further oncological
clearance is often recommended. This may result in an addi-
tional ablative defect, necessitating reconstructive surgery.
Suitable options from the reconstructive armamentarium are
limited due to surgical and patient factors, including fewer
available sources of donor tissue, advancing age and deleterious
local tissue effects after radiotherapy.
Reconstruction of the anterior chest wall, particularly
if irradiated, cannot be undertaken with simple tech-
niques. Skin grafts—despite being technically straightfor-
ward to perform—have clear disadvantages in terms of
reconstruction with negligible volume and low chance of
incorporation at the donor site. Microsurgical reconstruc-
tion using free flaps would provide the volume necessary
to reconstruct the defect and provide a desirable aesthetic
result. However, a history of irradiation in an increasing-
ly medically complex patient reduces the chance of flap
success. Furthermore, many patients with recurrent breast
cancer may decline lengthy surgery. Local flaps are lim-
ited as a proportion will have previously had a latissimus
dorsi (LD) breast reconstruction, thus reducing traditional
pedicled reconstructive options.
National conference presentation Association of Surgeons of Great
Britain and Ireland Annual Congress (Bournemouth, UK) May, 2008
(initial data presented)
C. R. Davis (*)
Department of Plastic and Reconstructive Surgery,
Frenchay Hospital, Bristol BS16 1LE, UK
Department of Medical Sciences, University of Bristol, Bristol, UK
S. J. Cawthorn
Department of Breast Surgery, Southmead Hospital, Bristol, UK
Eur J Plast Surg (2013) 36:749–756