We recommend an excision with a margin of 2 cm for cutaneous malignant melanoma with a tumor thickness > 0.8 and < or = 2.0 mm.

Different surgical techniques for subcutaneous mastectomy (SCM) have been evaluated and compared in this retrospective study of 72 patients. It has been clearly demonstrated that SCM followed by immediate reconstruction is a serious operation with a high frequency of both primary and late complications. It is important to have strong indications and a well informed and motivated patient before performing an SCM. A high frequency of postoperative tissue necroses was found for breasts of over 500 grams, when operated on using technique (VI) which entails skin reduction and transposition of the nipple-areola complex. In the very large breast a total mastectomy with skin reduction and transplantation of the nipple-areola complex is recommended. To obtain a good take of the graft it is advantageous to postpone the insertion of the prosthesis until a later occasion. For small breasts the lazy-S-shaped horizontal incision (technique V) is recommended. This technique gave perfect accessibility to the gland together with good cosmetic results and satisfied patients. At the follow-up examination it was found that the size and position of the implants were appropriate in about 80% of the breasts. Twenty-five per cent of the breasts were somewhat hard, although acceptable. The majority of the implants, however, were soft. The erotic sensibility of the breast is lost after an SCM.(ABSTRACT TRUNCATED AT 250 WORDS)

The report describes how the patients reacted to the information given them before the operation, their reactions following the operation, and their sexual behaviour before and after the operation. Patients who have undergone subcutaneous mastectomy with simultaneous insertion of implants have to cope with two different psychological factors: loss of the breast and sudden acquisition of an unfamiliar substitute. This study indicates that these factors may interfere with each other in a detrimental way. It may be better for patients if they are given opportunities to psychologically prepare themselves well in advance of the operation. Such preparation should include provision of full information and the opportunity to become familiar with the implants, as well as emotional counselling.

No abstract