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. 2010 Apr 29:10:171.
doi: 10.1186/1471-2407-10-171.

Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study

Affiliations

Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study

Sara Reefy et al. BMC Cancer. .

Abstract

Background: The management of early breast cancer (BC) with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on level-1 evidence. In this study, the oncological outcome, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis is evaluated.

Methods: 137 SSMs with IBR (10 bilateral) were undertaken in 127 consecutive women, using the LD flap plus implant (n = 85), LD flap alone (n = 1) or implant alone (n = 51), for early BC (n = 130) or prophylaxis (n = 7). Nipple reconstruction was performed in 69 patients, using the trefoil local flap technique (n = 61), nipple sharing (n = 6), skin graft (n = 1) and Monocryl mesh (n = 1). Thirty patients underwent contra-lateral procedures to enhance symmetry, including 19 augmentations and 11 mastopexy/reduction mammoplasties. A linear visual analogue scale was used to assess patient satisfaction with surgical outcome, ranging from 0 (not satisfied) to 10 (most satisfied).

Results: After a median follow-up of 36 months (range = 6-101 months) there were no local recurrences. Overall breast cancer specific survival was 99.2%, 8 patients developed distant disease and 1 died of metastatic BC. There were no cases of partial or total LD flap loss. Morbidities included infection, requiring implant removal in 2 patients and 1 patient developed marginal ischaemia of the skin envelope. Chemotherapy was delayed in 1 patient due to infection. Significant capsule formation, requiring capsulotomy, was observed in 85% of patients who had either post-mastectomy radiotherapy (PMR) or prior radiotherapy (RT) compared with 13% for those who had not received RT. The outcome questionnaire was completed by 82 (64.6%) of 127 patients with a median satisfaction score of 9 (range = 5-10).

Conclusion: SSM with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically safe for T(is), T1 and T2 tumours without extensive skin involvement.

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Figures

Figure 1
Figure 1
Skin sparing mastectomy and latissimus dorsi reconstruction. (a) Left skin sparing mastectomy and latissimus dorsi myocutaneous flap reconstruction in a 45 year old woman prior to nipple reconstruction and tattooing. (b) Magnified view of left side.
Figure 2
Figure 2
Skin sparing mastectomy and implant reconstruction. (a) Right skin sparing mastectomy and implant reconstruction. (b) Left skin sparing mastectomy and implant reconstruction in a 70 year old woman.
Figure 3
Figure 3
Nipple sparing mastectomy and implant reconstruction. (a) Bilateral nipple-sparing mastectomy and implant reconstruction. (b) Bilateral nipple-sparing mastectomy and implant reconstruction for bilateral breast cancer in a 57 year old woman.
Figure 4
Figure 4
Nipple reconstruction. Nipple reconstruction followed by tattooing.
Figure 5
Figure 5
Skin sparing mastectomy and latissimus dorsi flap with nipple reconstruction. Left skin sparing mastectomy and latissimus dorsi myocutaneous flap reconstruction, followed by nipple reconstruction and tattooing.
Figure 6
Figure 6
Skin sparing mastectomy and extended latissimus dorsi flap with nipple reconstruction. Right SSM and IBR using an extended LD flap without an implant in a 56 year old woman. She subsequently had nipple reconstruction using a free graft from the left nipple.

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