Mastectomy with one-stage or two-stage reconstruction in breast cancer: analysis of early outcomes and patient’s satisfaction

Abstract

Aim of this study is to compare early post-operative outcomes and patient’s satisfaction after skin-sparing and/or nipple-sparing mastectomy (SSM/SNSM) followed either by breast reconstruction with one-stage prepectoral implantation or two-stage technique for breast cancer (BC) or BRCA1/2 mutation.From January 2018 to December 2021, 96 patients (mean age of 51.12 ± 10.9) underwent SSM/SNSM and were divided into two groups: in group A (65 patients, 67.7%), mastectomy was followed by one-stage reconstruction; in group B (31 patients, 32.3%) by two-stage. Operative time was significantly longer in A vs. B (307.6 ± 95.7 vs. 254.4 ± 90.91; P < 0.05). Previous breast surgery was more common in B vs. A (29.0% vs. 7.7%; P < 0.05), while bilateral surgery was performed more frequently in A vs. B (40% vs. 6.5%; P = 0.001). All SSM/SNSM for BRCA1/2 mutation were followed by immediate prepectoral implantation. No significant differences were found between groups in terms of post-operative complications. At pathology, DCIS and invasive ST forms, such as multicentric/multifocal forms, were detected more frequently in B, while NST type in A (all P < 0.05). A multivariate analysis showed improved post-operative satisfaction at BREAST-Q survey in Group A (P = 0.001). Encouraging oncologic outcomes after SSM/SNSM for BC enabled the improvement of breast reconstructive techniques. One-stage reconstruction is characterized by better aesthetic outcomes and by greater patient’s satisfaction. When SSM/SNSM is technically difficult to perform, as in multicentric/multifocal forms or previous breast surgery, mastectomy followed by two-stage reconstruction should be considered to achieve a radical surgery.

Advances in Prepectoral Breast Reconstruction

“…During two-stage breast reconstruction, the breast are reconstructed by two separated surgeries. 40 During the first surgery, a tissue expander will be inserted under the chest muscle. The tissue expander is then slowly filled with saline over several weeks to stretch the skin and muscle, expand the volume of tissue in preparation for the final implant.…”

Breast cancer patient’s postoperative outcomes in nipple-sparing mastectomy and reconstruction with subpectoral implant placement: a single center experience

“…Fortunately, BC patients have the option to have breast reconstruction after mastectomy and, in particular, immediate breast reconstruction (IBR) may severely improve their quality of life (QoL) [6]. The IBR is proposed to women who observe speci c criteria, and it has the advantage of a single hospital admission and improved psychological outcomes [7]. Several surgical techniques may be pursued for IBR after mastectomy and can be divided into 2 large groups: implant-based reconstruction and autologous reconstruction [8].…”