A single institution experience with skin sparing mastectomy and immediate breast reconstruction

Abstract

According to the NHS Information Centre's Hospital Episode Statistics, 131,566 women in England were diagnosed with breast cancer in [2004][2005]. Of these, 16,838 underwent a mastectomy, of which only 1,623 (9.6%) benefited from a skin sparing approach. It is expected that almost all women who have been recommended a mastectomy will be offered reconstruction in the immediate setting or as a delayed procedure. Skin sparing mastectomies (SSMs) and immediate breast reconstruction (IBR) preserves the natural contours by sparing the native skin, preserves sensation, minimises scars, gives cosmetic results (thereby increasing self esteem) and lowers psychological morbidity.1 Oncological safety in terms of local and systemic recurrence is a serious concern. MethodsA retrospective study was carried out on all patients with breast cancer treated with an SSM and IBR over a six-year period from 1999 to 2005. A single consultant breast surgeon carried out all SSMs and IBRs in a single institution. All patients were discussed in our local multidisciplinary meeting before and after surgery. ResultsA total of 108 patients, with a mean age of 49 years (range: 28-70 years), underwent an SSM and IBR, of which 78 patients (72.22%) had invasive cancer and 30 (27.78%) had a ductal carcinoma in situ (DCIS) only. Of the invasive cancers, 63 were ductal, 9 were lobular and 6 had other histological types. The mean tumour size of the invasive cancers on final histology was 29.9mm and ranged from 2mm to 100mm. Tumour grade (modified Scarff-Bloom-Richardson grading system), 2,3 lymph node involvement, lymphovascular invasion and receptor status are given in Table 1, Nottingham prognostic index in Table 2 and TNM (tumour, nodes, metastasis) staging 4 in Table 3. In our series of 108 patients, 67 patients had a primary mastectomy, 27 had a completion mastectomy and 8 patients underwent an SSM for recurrence after breast conserving surgery. Four patients had a bilateral SSM for bilateral disease. Three patients opted for a contralateral prophylactic mastectomy.Seventy-five patients (69.44%) had a latissimus dorsi flap with or without an implant and five patients (4.62%) underwent reconstruction utilising a pedicled transverse rectus abdominis myocutaneous flap. The other 28 patients (25.93%) had implant-based reconstruction only.Of the 25 patients who had post-reconstruction radiotherapy, 9 developed a capsular contracture and 8 of these required an exchange of implant. Thirty-three patients (30.56%) had chemotherapy, of whom 20 required adjuvant radiotherapy as well. Two patients in our series had neoadjuvant chemotherapy prior to their SSM and IBR. In two patients there was a delay of two months in commencement

Oncologic Safety of Immediate Breast Reconstruction for Invasive Breast Cancer Patients: A Matched Case Control Study

“…However, the average weight of the residual breast tissue in SSM was found to be a mere 0.02% of the total removed tissue [ 3 14 ]. Additionally, Doddi et al [ 15 ] indicated that locoregional recurrence after IBR cannot be affected by inadequate excision alone, but it is more affected by other prognostic factors. Many previous reports found similar results to those in our study, demonstrating no difference between SSM or NSM and conventional mastectomies [ 8 9 11 12 16 ].…”