Analysis of Skin Flap Thickness and Residual Breast Tissue After Mastectomy

Giannotti, Daniela Gregolin; Hanna, Samir Abdallah; Cerri, Giovanni Guido; Bevilacqua, José Luiz Barbosa

doi:10.1016/j.ijrobp.2018.05.023

Cited by 55 publications

(35 citation statements)

References 32 publications

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“…In a recent issue of the Red Journal, Giannotti et al report the results of an elegant analysis using magnetic resonance imaging to better quantify the variation in skin flap thickness in 501 postmastectomy breasts (in 367 women; mostly with breast cancer, but also including some undergoing elective/prophylactic surgery) (14). They demonstrate that skin flap thickness varies by location (thinner in the central [mean z 6-10 mm] vs peripheral [mean z 14-24 mm] regions of the breast), and there is much interpatient variation (eg, standard deviations range from z 6-14 mm for the different regions; personal communication with the authors, July 2018).…”

mentioning

confidence: 99%

Mastectomy May Be an Inferior Oncologic Approach Compared to Breast Preservation

Marks

Gupta

Muss

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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mentioning

confidence: 99%

Mastectomy May Be an Inferior Oncologic Approach Compared to Breast Preservation

Marks

Gupta

Muss

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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“…Within the breast, the skin flap was thicker on the periphery than in the central regions. They did not find any significant difference in tumor recurrence in relation to the presence of residual breast tissue and flap thickness (42). Wiberg also demonstrated differences in skin flap thickness between the different breast quadrants, by analyzing 45 women who had undergone prophylactic mastectomy.…”

Section: Discussionmentioning

confidence: 97%

Pattern of local recurrence after mastectomy and reconstruction in breast cancer patients: a systematic review

Joo¹,

Ki²,

Kim³

et al. 2021

Gland Surg

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Background: This study aimed to describe the locations of local recurrences based on the mastectomy and reconstruction type in breast cancer patients.Methods: In November 2020, a systematic literature review was performed through MEDLINE/PubMed and the Cochrane Centre Register of Controlled Trials. Publications that included skin-sparing or nipplesparing mastectomy followed by breast reconstruction and described the location of local recurrences were analyzed. Exclusion criteria included salvage or prophylactic mastectomy, unclear distinction between local and regional recurrences, rare tumor types.Results: From 19 publications, 272 local recurrences lesions were reported in a total of 4,787 patients.After autologous reconstruction (n=2,465), local recurrences were located in the skin in 45 (1.8%) patients, in the chest wall in 18 (0.7%), and in the nipple-areolar complex in 9 (0.4%). After implant reconstruction (n=1,917), local recurrences sites included the skin in 91 (4.7%) patients, chest wall in 8 (0.4%), and nippleareolar complex in 8 (0.4%). Of the 70 lesions with reported in-breast location, 57 (81.4%) relapsed in the original tumor location.Discussion: Although meta-analysis was not conducted, present analysis demonstrated that most local recurrences after skin-sparing or nipple-sparing mastectomy occurred within the skin or subcutaneous tissues. It was found that the original tumor location was the most frequent site of relapse. Therefore, special attention should be paid to the original tumor overlying the skin while planning postmastectomy radiation therapy.

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“…The presence of residual breast tissue in the NAC is not surprising in this study. Presence of RBT after open NSM is not uncommon and is most common in tissue behind the NAC [ 23 , 24 ]. In a study using MRI to evaluate for RBT after mastectomy, the overall frequency of RBT was 77.8% and when the NAC region was excluded, the frequency of RBT was 51.6% in NSMs [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…This phenomenon may be due to lack of Cooper’s ligaments under the NAC, leading to more difficult precise dissection in the dermis-fibroglandular tissue junction [ 25 ]. More importantly, the incidence of local recurrence after open NSM is low despite the presence of RBT [ 2 , [26] , [27] , [28] ]. Nipple areolar complex recurrence after open NSM ranges from 0 to 7% in most recent series [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Residual breast tissue after robot-assisted nipple sparing mastectomy

et al. 2021

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Introduction: While the long-term oncologic safety of robot-assisted nipple sparing mastectomy (RNSM) remains to be elucidated, histologically detected residual breast tissue (RBT) can be a surrogate for oncologically sound mastectomy. The objective of this study is to determine the presence of RBT after RNSM. Methods: Between August 2019eJanuary 2020, we completed 5 cadaveric RNSMs. Full thickness biopsies from the mastectomy skin flap were obtained from predefined locations radially around the mastectomy skin envelop and nipple areolar complex to histologically evaluate for RBT. Results: The first case was not technically feasible due to inability to obtain adequate insufflation. Five mastectomy flaps were analyzable. The average mastectomy flap thickness was 2.3 mm (range 2e3 mm) and the average specimen weight was 382.72 g (range 146.9e558.3 g). Of 70 total biopsies, RBT was detected in 11 (15.7%) biopsies. Most common location for RBT was in the nipple-areolar complex, with no RBT detected from the peripheral skin flaps. Conclusions: In this cadaveric study, RNSM is feasible leaving minimal RBT on the mastectomy flap. The most common location for RBT is in the periareolar location consistent with previous published findings after open NSM. Clinical studies are underway to evaluate the safety of RNSM.

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Analysis of Skin Flap Thickness and Residual Breast Tissue After Mastectomy

Cited by 55 publications

References 32 publications

Mastectomy May Be an Inferior Oncologic Approach Compared to Breast Preservation

Mastectomy May Be an Inferior Oncologic Approach Compared to Breast Preservation

Pattern of local recurrence after mastectomy and reconstruction in breast cancer patients: a systematic review

Residual breast tissue after robot-assisted nipple sparing mastectomy

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