Abstract
The popularity of skin-sparing mastectomy (SSM) which preserves the breast skin envelope is increasing, but the risks and benefits of this approach are only beginning to emerge. A technique involving ultra-conservative SSM and immediate breast reconstruction (IBR) has been evaluated to establish the surgical and oncological sequelae of skin conservation. Between 1994-1998, 67 consecutive patients underwent 71 SSM and expander-assisted immediate latissimus dorsi (LD) breast reconstructions (follow up, 24.1 months; range, 2-52 months). Breast resection, axillary dissection and reconstruction were performed through a 5-6 cm circular peri-areolar 'keyhole' incision. Patients were discharged 6.5 days (range, 5-15 days) after the 3.9 h (range, 3.0-5.5 h) procedure, and expansion was completed by 4.0 months (range, 0-10 months). Local recurrence occurred in 3% of breasts at risk, skin envelope necrosis occurred in 10%, and contralateral surgery was required to achieve symmetry in 14%. SSM and IBR is an oncologically safe, minimal-scar procedure which can be performed by surgeons trained in 'oncoplastic' techniques. It results in low rates of local recurrence and complication, and reduces the need for contralateral surgery.
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- Barton F. E., Jr, English J. M., Kingsley W. B., Fietz M. Glandular excision in total glandular mastectomy and modified radical mastectomy: a comparison. Plast Reconstr Surg. 1991 Sep;88(3):389–394. doi: 10.1097/00006534-199109000-00001. [DOI] [PubMed] [Google Scholar]
- Bensimon R. H., Bergmeyer J. M. Improved aesthetics in breast reconstruction: modified mastectomy incision and immediate autologous tissue reconstruction. Ann Plast Surg. 1995 Mar;34(3):229–235. doi: 10.1097/00000637-199503000-00002. [DOI] [PubMed] [Google Scholar]
- Cady B. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy: another editorial perspective. Ann Surg Oncol. 1998 Mar;5(2):103–104. doi: 10.1007/BF02303840. [DOI] [PubMed] [Google Scholar]
- Carlson G. W., Bostwick J., 3rd, Styblo T. M., Moore B., Bried J. T., Murray D. R., Wood W. C. Skin-sparing mastectomy. Oncologic and reconstructive considerations. Ann Surg. 1997 May;225(5):570–578. doi: 10.1097/00000658-199705000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dean C., Chetty U., Forrest A. P. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet. 1983 Feb 26;1(8322):459–462. doi: 10.1016/s0140-6736(83)91452-6. [DOI] [PubMed] [Google Scholar]
- Eberlein T. J., Crespo L. D., Smith B. L., Hergrueter C. A., Douville L., Eriksson E. Prospective evaluation of immediate reconstruction after mastectomy. Ann Surg. 1993 Jul;218(1):29–36. doi: 10.1097/00000658-199307000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Elkowitz A., Colen S., Slavin S., Seibert J., Weinstein M., Shaw W. Various methods of breast reconstruction after mastectomy: an economic comparison. Plast Reconstr Surg. 1993 Jul;92(1):77–83. doi: 10.1097/00006534-199307000-00011. [DOI] [PubMed] [Google Scholar]
- Furey P. C., Macgillivray D. C., Castiglione C. L., Allen L. Wound complications in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction for breast cancer. J Surg Oncol. 1994 Mar;55(3):194–197. doi: 10.1002/jso.2930550313. [DOI] [PubMed] [Google Scholar]
- Hidalgo D. A. Aesthetic refinement in breast reconstruction: complete skin-sparing mastectomy with autogenous tissue transfer. Plast Reconstr Surg. 1998 Jul;102(1):63–72. doi: 10.1097/00006534-199807000-00009. [DOI] [PubMed] [Google Scholar]
- Kroll S. S., Schusterman M. A., Tadjalli H. E., Singletary S. E., Ames F. C. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy. Ann Surg Oncol. 1997 Apr-May;4(3):193–197. doi: 10.1007/BF02306609. [DOI] [PubMed] [Google Scholar]
- O'Rourke S., Galea M. H., Morgan D., Euhus D., Pinder S., Ellis I. O., Elston C. W., Blamey R. W. Local recurrence after simple mastectomy. Br J Surg. 1994 Mar;81(3):386–389. doi: 10.1002/bjs.1800810321. [DOI] [PubMed] [Google Scholar]
- Roberts A. C., Coleman D. J., Sharpe D. T. Custom-made nipple-areola prostheses in breast reconstruction. Br J Plast Surg. 1988 Nov;41(6):586–587. doi: 10.1016/0007-1226(88)90165-8. [DOI] [PubMed] [Google Scholar]
- Rosato R. M., Dowden R. V. Radiation therapy as a cause of capsular contracture. Ann Plast Surg. 1994 Apr;32(4):342–345. doi: 10.1097/00000637-199404000-00002. [DOI] [PubMed] [Google Scholar]
- Roy M. K., Shrotia S., Holcombe C., Webster D. J., Hughes L. E., Mansel R. E. Complications of latissimus dorsi myocutaneous flap breast reconstruction. Eur J Surg Oncol. 1998 Jun;24(3):162–165. doi: 10.1016/s0748-7983(98)92810-4. [DOI] [PubMed] [Google Scholar]
- Sandelin K., Billgren A. M., Wickman M. Management, morbidity, and oncologic aspects in 100 consecutive patients with immediate breast reconstruction. Ann Surg Oncol. 1998 Mar;5(2):159–165. doi: 10.1007/BF02303849. [DOI] [PubMed] [Google Scholar]
- Slavin S. A., Schnitt S. J., Duda R. B., Houlihan M. J., Koufman C. N., Morris D. J., Troyan S. L., Goldwyn R. M. Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg. 1998 Jul;102(1):49–62. doi: 10.1097/00006534-199807000-00008. [DOI] [PubMed] [Google Scholar]
- Wellisch D. K., Schain W. S., Noone R. B., Little J. W., 3rd Psychosocial correlates of immediate versus delayed reconstruction of the breast. Plast Reconstr Surg. 1985 Nov;76(5):713–718. doi: 10.1097/00006534-198511000-00010. [DOI] [PubMed] [Google Scholar]
- Yule G. J., Concannon M. J., Croll G., Puckett C. L. Is there liability with chemotherapy following immediate breast construction? Plast Reconstr Surg. 1996 Apr;97(5):969–973. doi: 10.1097/00006534-199604001-00013. [DOI] [PubMed] [Google Scholar]
- von Smitten K., Sundell B. The impact of adjuvant radiotherapy and cytotoxic chemotherapy on the outcome of immediate breast reconstruction by tissue expansion after mastectomy for breast cancer. Eur J Surg Oncol. 1992 Apr;18(2):119–123. [PubMed] [Google Scholar]