Modified Skin Incisions for Mastectomy

Toth, Bryant A.; Lappert, Patrick W.

doi:10.1097/00006534-199106000-00006

Cited by 388 publications

(56 citation statements)

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“…In an attempt to decrease morbidity and improve functional outcome, 1960 witnessed the surgical evolution from the radical mastectomy to the modified radical mastectomy and in 1969 the WHO approved randomized control trial comparing radical mastectomy to quadrentectomy [5]. Then, it came the idea of skin sparing mastectomy described by Toth and Lambert in 1991 [6]. The natural progression from skin preservation would be nipple-preservation.…”

Section: Introductionmentioning

confidence: 99%

Aesthetic Outcome after Nipple Sparing Mastectomy for Cancer Patient Egyptian Pattern

Farahat¹,

Hashem²,

Abdalwahab³

et al. 2017

ABCR

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Background: Recent advances in breast reconstruction and the introduction of oncoplastic techniques have resulted in significant improvement in quality of life and psychological well-being of most patients. Nipple sparing mastectomy is a surgical technique that removes breast tissue while preserving the native skin envelope, infra-mammary fold and the NAC, which allows immediately reconstructed breasts to have an excellent cosmetic outcome. Aim: Our primary end point was for objective assessment of aesthetic outcome after NSM via more accurate new method and subsiding bias in that assessment and the secondary end point was for evaluating the influence of incision choice and recommending which incision is the best for each patient putting in mind cup size, degree of ptosis and body mass index of Egyptian patients. Methods: Starting January 2013 to November 2015, 74 patients with breast cancer underwent NSM with immediate reconstruction using LD flap with or without implant augmentation. Results: Incisions used are elliptical (37.8%), lateral (27%), peri-areolar (21.6%) and infra-mammary (13.5%). In 81.1% of the patients, the procedure was performed using extended LD flaps only, while in the remaining 18.9% the flaps were augmented using implant insertion. Axillary dissection was done in 68.9% of patients and SLN in 24.3% of patients. Overall aesthetic results were done by patient self-assessment, assessment by the surgeon, assessment by professional plastic breast surgeon and assessment by onco-plastic surgeon, and this was followed by statistical analysis of the agreement between the plastic surgeon and the onco-plastic surgeon. Conclusion: NSM is safe, feasible and offers adequate oncologic results along with excellent cosmetic outcome. Choice of incision and reconstruction should be tailored to suit each patient. Breast cancer patients can benefit from sound resection and enjoy a sense of wholeness.

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Section: Introductionmentioning

confidence: 99%

Aesthetic Outcome after Nipple Sparing Mastectomy for Cancer Patient Egyptian Pattern

Farahat¹,

Hashem²,

Abdalwahab³

et al. 2017

ABCR

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“…Skin-sparing mastectomy (SSM), a type of mastectomy where incisions are planned to maximise skin preservation and facilitate breast reconstruction, was described by Toth and Lappert in 1991 [4]. SSM involving enbloc removal of the breast gland, nipple-areola complex (NAC), may also include previous biopsy sites and the skin overlying superficial tumours.…”

Section: Introductionmentioning

confidence: 99%

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Kasem¹,

Choy²,

Mokbel³

2014

JCT

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Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC < 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nippleareola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New techniques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.

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“…Skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) was first reported by Toth and Lappert [15] in 1991 and is generally acknowledged to be a method that can achieve both a radical cure and excellent cosmetic outcomes. Recently, nipple-sparing mastectomy was introduced, which combines SSM with preservation of the nipple–areolar complex.…”

Section: Introductionmentioning

confidence: 99%

Clinical comparison of four types of skin incisions for skin-sparing mastectomy and immediate breast reconstruction

et al. 2013

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PurposeSkin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) has become popular as an effective procedure for patients with early breast cancer. We herein report an overview of the four types of skin incisions used for SSM.MethodsThe records of 111 consecutive breast cancer patients, who received SSM and IBR from 2003 to 2012, were reviewed retrospectively. Four types of skin incisions were used. Type A was the so-called tennis racquet incision, type B was a periareolar incision and mid-axillary incision, type C was the so-called areola-sparing with mid-axillary incision and type D was a small transverse elliptical incision and transverse axillary incision.ResultsTwenty-six type A, 59 type B, 20 type C and six type D incisions were made. The average blood loss and average length of the operation during SSM were not significantly different between the four approaches. The average areolar diameter was 35 mm for type A, B and D incisions, and 45 mm for type C. There was a need for postoperative nipple–areolar complex plasty (NAC-P) in 75 % of the cases following type A, B and D incisions, and 35 % of the cases treated using type C incisions.ConclusionThe type C incision is superior with regard to the cost and cosmetic outcomes, because fewer of these patients request postoperative NAC-P.

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Modified Skin Incisions for Mastectomy

Cited by 388 publications

References 0 publications

Aesthetic Outcome after Nipple Sparing Mastectomy for Cancer Patient Egyptian Pattern

Aesthetic Outcome after Nipple Sparing Mastectomy for Cancer Patient Egyptian Pattern

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Clinical comparison of four types of skin incisions for skin-sparing mastectomy and immediate breast reconstruction

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