Introduction
Bone metastasis is a frequent complication of cancer. It occurs in up to 70% of patients with advanced breast or prostate cancer and in approximately 15% to 30% of patients with carcinoma of the lung, colon, stomach, bladder uterus, rectum, thyroid or kidney. Breast cancer has the tendency to relapse in the bones, and 56% of autopsy cases reveal the occurrence of bone metastasis. The most frequent sites of bone metastasis are the thoracic and lumbosacral spine. The consequences of bone metastasis are often devastating, as only 20% of patients with breast cancer are still alive five years after the discovery of bone metastasis. Chest wall resection for breast cancer was first performed by Schede in 1866 and then by Sauerbruch in 1907. Meanwhile, partial sternectomy for a primary sarcoma was first described by Holden in 1878. In 1959, Brodin and Linden first performed and described total sternectomy due to chondrosarcoma involving the entire sternum.
The surgical treatment of chest wall tumors challenges the aggressiveness and ingenuity of the operating surgeon who closes the defect. Partial or total sternectomy, together with rib resection, are common thoracic surgical procedures. These are undertaken for primary and secondary tumors arising from any of the structures forming the chest wall, as well as recurrent breast cancer or lung tumors invading the chest wall. Myocutaneous flaps and prosthetic materials greatly facilitate reconstruction after massive chest wall resection.