Title: Skin Sparing Mastectomy with Immediate Breast Reconstruction by Augmentation Flap in Early Breast Cancer
Authors: Nasir U Din Wani, Shabir Iqbal, Khursheed Alam, Ajaz Malik, Adil Hafiz
DOI: https://dx.doi.org/10.18535/jmscr/v5i1.10
Abstract
Skin sparing mastectomy (SSM) refers to the maximum preservation of patients own skin with the removal of only nipple- areola complex and any breast skin involved with or close to the tumor. The aim of the study was to analyze the applicability of SSM with IBR, comparison of breast conserving surgery without reconstruction and SSM with IBR in terms of patient satisfaction, psychological impact and local recurrence rate, and follow up of patients in prospective group to look for cosmesis, breast mound, breast skin color and flap necrosis. 20 patients of early breast cancer in prospective group were subjected to SSM and IBR and compared with all the patients of early breast cancer who were admitted in the Department of General Surgery for breast conserving surgery. The mean age in the prospective group was 43.7 years with a mean hospital stay of 4.8 days. Most (60%) of the patients were in stage II. 95% of the patients were having duct cell carcinoma on FNAC. In the prospective group, all the patients were subjected to SSM and IBR by Latissimus dorsi myocutaneous flap followed by post-operative chemotherapy and radiotherapy. In prospective group, none of the patients had local recurrence, 90% of the patient had positive psychological impact, 85% of the patients had good satisfaction and 75% of the patients had good post-reconstruction cosmesis. It was concluded that SSM is oncologically safe and SSM and IBR are appropriate treatment for patients with early breast cancer; the use of SSM has improved breast reconstruction outcomes and has thereby enhanced the quality of life of our patients.
Keywords: Skin sparing mastectomy; breast reconstruction; early breast carcinoma, latissimus dorsi flap; flap necrosis; cosmesis.
References
1. 1. Sanjit Bagchi. Breast cancer rises in India. CMAJ. 2008.
2. Millard DR Jr. Principlization of Plastic Surgery. Little, Brown, Boston, 1986.
3. Toth BA, Lappert P. Modified skin incisions for mastectomy: the need for plastic surgical input in pre-operative planning. Plast Reconstr Surg.1991; 87: 1048.
4. Singletary SE. Skin sparing mastectomy and immediate breast reconstruction. Med Gen Med.1999; 1(1) [Formally published in Medscape Women’s Health Journal. 1996;1(5).
5. Veronesi U, Banfi A, Salvadori B. Breast conservation is the treatment of choice in small breast cancer: long term results of a randomized trial. Eur J Cancer 1990; 26: 668.
6. Schain Ws, Wellisch DK, Pasnau RO, et al. The sooner the better: a study of psychological factors in women underg-oing immediate versus delayed breast reconstruction. Am J Psychiatry 1985; 142: 40.
7. Noone RB, Frazier TG, Hayward CZ, et al. Patient’s acceptance of immediate reconstruction following mastectomy. Plast Reconstr Surg 1982; 69: 632.
8. Carlson GW. Skin sparing mastectomy: anatomic and technical considerations. Am Surg.1996; 62: 151.
9. Sampaio Goes J. Mastectomy by periareolar approach with immediate breast reconstruction. Rev Loc Bras Cir Estet Reconstr.1995; 10: 44.
10. D. Lehman, M.D.,Ph.d., et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. The New Engl J Med.2007;356:13..
11. Renato Z T, Cesar C S, Henrique Brenelli et al. Residual glandular tissue after skin sparing mastectomies. The Breast Journal, Volume 11, number 5, 2005:374-375.
12. Newman LA, Kuerer HM, Hunt KK, et al. Feasibility of immediate breast reconstruction for locally advanced breast cancer. Ann surg oncol 1999; 6: 671-675.
13. Foster RD, Esserman LJ, Anthony JP, et al. Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast carcinoma. Ann surg oncol 2002; 9: 462-466.
14. Downes KJ, Glatt BS, Kanchwala SK, et al. Skin-sparing mastectomy and immed-iate breast reconstruction is an acceptable treatment option for patients with high risk breast carcinoma. Cancer 2005; 103: 906-913.
15. Schneider W, Hill L, Brown GR. Latissi-mus Dorsi myo-cutaneous flap for breast reconstruction. Br J Plast Surg. 1977; 30:277
16. Bostwick J III, Scheflan M. the Latissimus Dorsi myo-cutaneous flap; A one stage breast reconstruction. Clin Plast Surg. 1980; 7:71.
17. Hartrampf CR Jr., Scheflan, Black PW. Breast reconstruction following mastec-tomy with a transverse abdominal island flap. Anatomical and clinical observations. Plast. Reconstr. Surg. 1982; 69:216.
18. Hartrampf CR (ed). Breast reconstruction with living tissue, New York, Raven Press, 1990.
19. Hartrampf CR Jr. abdominal wall compet-ence in transverse abdominal island flap operations. Ann Plast Surg.1984; 12:139.
20. Lejour M, Dome. Abdominal wall function after rectus abdominis transfer. Plast reconstr Surg.1991; 87:1054.
21. Kroll SS, Marchi M. Comparison of strategies for preventing abdominal wall weakness after TRAM flap breast reconstr-uction. Plast Reconstr Surg.1991; 89:1045.
22. Mizgala CL, Hartrampf CR Jr. Bennet GK. Abdominal function after pedicled TRAM flap surgery. Clin Plast Surg.1994; 21(2):255.
23. Ho CM, Mak Ck, Lau Y, et al. Skin involvement in invasive breast carcinoma: safety of skin-sparing mastectomy. Ann Surg Oncol 2003; 10: 102-107.
24. Mauriac L. et al: Effects of primary chemotherapy in conservative treatment of breast cancer patients with operable tumors more than 3 cm: results of a randomized trial in a single centre, Ann Oncol 1991: 2; 347.
25. Hagenson CD: Disease of breast, ed 2, Philadelphia, 1971.
26. Fisher B et al. Ten year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation, N Engl J Med 1985: 312; 674.
27. National Institute of Health Centre Consensus development panel: Adjuvant therapy for breast cancer, Nov 1-3, 2000, J Natl Cancer Inst 2001: 93; 979.
28. Carlson GW, Sttyblo TM, Lyles RH, et al. Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism? Ann surg oncol 2003; 10: 108- 112.
29. Medina-Franco H, Vasconez LO, Fix RJ, et al. Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Ann surg 2002; 235: 814-819.
30. Early Breast Cancer Trialist Group: Favorable and unfavorable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomized trials, Lancet 2000: 355; 1757.
31. Renneker, R., and Culter, M. Psycholo-gical problems of adjustment to cancer of the breast. J.A.M.A.1952;148:833.
32. Mamoon Rashid, Irfan Ilahi, et al. Skin sparing mastectomy and immediate breast reconstruction. JCPSP 2005, vol. 15 (8):467-471.
33. Slavin SA, Schnitt SJ, Duda RB, et al. Skin-sparing mastectomy and immediate reconstruction; oncologic risks and aesthetic results in patients with early stage breast cancer. Plast Reconstr Surg 1998; 102; 49-62.