Skin-reducing mastectomy and immediate breast reconstruction in patients with macromastia

Abstract

IntroductionIn women with macromastia, a type IV skin sparing mastectomy is often required to achieve an aesthetically pleasing reconstruction. The introduction of “skin-reducing mastectomy”, which inserts a permanent prosthetic device into a large pouch made by the pectoralis major muscle and an inferior pedicle dermal flap, allows the surgeon to achieve a safe oncologic result plus a cosmetically satisfying reconstruction.ObjectiveWe report here our experience with the skin-reducing mastectomy with the aim of emphasizing the problems associated with the technique.Materials and methodA study was conduced from April 2009 to November 2012, 74 patients with breast cancer were selected then received a skin-reducing mastectomy. The enrolled women satisfied the criteria of Nava. Statistical analysis was conduced to estimate the significance of the outcome results and complication rate.ResultA total of 88 SRMs were performed and the outcomes were as follows: excellent in 34 patients, good in 21, and poor in 8. We recorded 25 % of adverse events and statistic helped us to identify patient related factors whose can increase the complications onset.ConclusionSkin-reducing mastectomy is an indispensable procedure to treat cancer in large and pendulous breasts.The correct patient selection is mandatory to reduce the not negligible complication risk. Skin reducing mastectomy when is well conduced allow to obtain good results with patient satisfaction but, like other breast-conserving surgeries, in some case is not the ultimate solution, because it may require some revisions to maintain the optimum results.To day it be consider relatively safe in selected patient and the gold standard in macormastia immediate reconstruction.

The Bell Pattern: A Novel Breast Incision Approach to Skin-Reducing Mastectomies

“… 21 , 31 In our study, average permanent implant volume was 550cc with a high of 700cc, without any implant loss or major complication. In contradistinction, De Vita et al 32 reported an average implant volume of 478cc utilizing a Wise pattern SRM and had a significant major complication rate of 29%. Irwin et al 21 obtained a 420cc median fill with partial submuscular Wise pattern DTI reconstruction but had an implant failure rate of 3.8%.…”

“…As our goal was to ascertain safety with a novel skin excision, we excluded patients with certain known risk factors for reconstruction failure, such as active nicotine use, 37 BMI >35, 33 and previous history of breast radiation. 38 However, other known risk factors were not excluded and were represented in our cohort: breast weight >600 g, 5 , 22 , 39 , 40 age greater than 65, 41 bilateral reconstructions, 42 , 43 immediate DTI reconstructions, 34 BMI >30, 33 , 42 implant volume >500cc, 32 ADM, 44 patients requiring PMRT, 38 , 45 and invasive breast disease. 46 …”

Clinical experience with Surgimend in breast reconstruction: an overview

“…The use of SurgiMend was also described after skin-reducing mastectomy in patients needing a very large implant, for which dermal and anterior serratus flaps were inadequate (De Vita et al, 2015). Generally, the use of acellular dermal matrix had been reserved for patients who have undergone previous breast surgery such as quadrantectomy, for patients with extremely high insertions of their pectoralis muscle, and for patients needing a large breast implant or large pouch.…”

Mastectomía ahorradora de piel tipo IV con injerto libre de areola-pezón para reconstrucción con prótesis en cirugia reductora de riesgo

“…De Vita y col. consideran este procedimiento como la técnica más adecuada para la reducción de riesgo de padecer cáncer mamario en pacientes con macromastia. (15) La MIVAP permite realizar la mastectomía reductora de riesgo, la reducción y la reconstrucción mamaria en un solo tiempo quirúrgico, cumpliendo adecuadamente con los 3 objetivos cuyo beneficio redunda en una menor cantidad de actos quirúrgicos y/o anestésicos, menos periodos de inactividad laboral y mejor recuperación de los tejidos tras una única intervención. (16)…”