Reconstrucción mamaria inmediata en el Instituto Nacional de Oncología y Radiobiología de Cuba / Immediate Breast Reconstruction at the National Institute of Oncology and Radiobiology of Cuba

RESUMEN Introducción: La reconstrucción mamaria inmediata disminuye el impacto psicológico del cáncer de mama y mejora la calidad de vida de las pacientes. Objetivo: Evaluar la simetría en la reconstrucción mamaria inmediata en el Instituto Nacional de Oncología y Radiobiología de Cuba. Método: Se realizó un estudio analítico y prospectivo, de cohorte incidente, en el Servicio de Cirugía Reconstructiva del Instituto Nacional de Oncología y Radiobiología de 2014 al 2017. Se incluyeron 41 pacientes que consintieron participar en el estudio. Se recogieron variables demográficas y onco-reconstructivas. Se utilizó un software creado en la institución para evaluar la simetría mamaria. Los datos se recogieron de la historia clínica. Se aplicaron el test de Chi-cuadrado corregido y la razón de momios para el análisis estadístico. Resultados: El 30,2 por ciento de mujeres reconstruidas pertenecieron al grupo de 30 a 39 años; el 46,3 por ciento tenían sobrepeso. La mejor simetría se encontró con las técnicas oncoplásticas (31,7 por ciento), seguida de la mastectomía ahorradora de piel. La técnica de expansión tisular con la mastectomía presentó mayores complicaciones (63,6 por ciento) y menor simetría. La necrosis parcial de piel fue la mayor complicación en 7,3 por ciento y estuvo relacionadas con las técnicas ahorradoras de piel. Conclusiones: Evaluar de forma objetiva la simetría mamaria permitió conocer la efectividad de las técnicas quirúrgicas reconstructivas. Con las técnicas de cirugía oncoplástica y mastectomía ahorradora de piel se obtuvieron los mejores resultados estéticos y pocas complicaciones. La expansión mamaria inmediata con una mastectomía radical modificada no ofrece ninguna ventaja(AU)

ABSTRACT Introduction: Immediate breast reconstruction reduces the psychological impact of breast cancer and improves the quality of life of patients. Objective: To assess symmetry in immediate breast reconstruction at the of Cuba. Method: An analytical and prospective study of incident cohort was carried out in the reconstructive surgery service at the National Institute of Oncology and Radiobiology (INOR), from 2014 to 2017. Forty-one patients who consented to participate in the study were included. Demographic and oncoreconstructive variables were collected. A software created in the institution was used to assess breast symmetry. The data were collected from the medical histories. The corrected chi-square test and odds ratio were applied for statistical analysis. Results: 30.2 percent of women who received reconstruction belonged to the age group 30-39 years; 46.3 percent were overweight. The best symmetry was found with oncoplastic techniques (31.7 percent), followed by skin-sparing mastectomy. The tissue expansion technique with mastectomy presented greater complications (63.6 percent) and less symmetry. Partial skin necrosis was the major complication, accounting for 7.3 percent of the cases, and was related to skin-sparing techniques. Conclusions: Objectively evaluating breast symmetry allowed us to know the effectiveness of reconstructive surgical techniques. With oncoplastic surgery and skin-sparing mastectomy techniques, the best aesthetic outcomes and few complications were obtained. Immediate breast expansion with a modified radical mastectomy offers no benefit(AU)

Management of huge defects following extensive abdominal wall neoplasm resection: classification and immediate reconstruction / 中华普通外科杂志

Objective To evaluate the effect of extensive resection and immediate reconstruction based on classification of abdominal wall defects for patients with abdominal wall neoplasms.Methods From Jan 1999 to May 2016,112 patients with abdominal wall neoplasms were treated with extensive resection,including Type Ⅰ (n =20),Type Ⅱ (n =45) and Type Ⅲ (n =47).Immediate abdominal wall reconstruction comprised primary sutures or free skin graft for Type I defects,component separation (CST) with or without a prosthetic or biological mesh reinforcement for Type Ⅱ defects and pedicled or vascularized myocutaneous flap with or without a prosthetic or biological mesh or prosthetic + biological mesh with or without CST for Type Ⅲ defects.Results The average follow up was 76.86 ± 21.22 months,3 patients developed flap necrosis,9 patients suffered from wound infection.Local recurrence was observed in 20 patients,35 patients developed distant metastasis.Conclusions The optimal strategy based on the abdominal wall defect classification for immediate reconstruction of huge abdominal wall defects is safe and effective after resection of abdominal wall neoplasms.

Clinical application of immediate latissimus dorsal myocutaneous flap in breast reconstruction after partial re-moval of breast / 中华医学美学美容杂志

Objective To study the immediate conservative breast surgical reconstruction by trans-ferring the same lateral latissimus dorsal myocutaneous flap (LDM) for the treatment of stage Ⅱ and stage Ⅲ breast cancer, combined with neoadjuvant chemotherapy. Methods Breast cancer patients in stage Ⅱ and Ⅲ with pathological diagnosis by core needle biopsy, had undergone immediate conservative breast reconstruction surgery with transferring the latissimus dorsal myocutaneous (LDM). We scored the reconstructed breast twice at one month after operation and completion of radiation. The final score was decided using the mean value of the twice evaluating score. Kaplan-Meier survival was used to analyze the survival of 18 cases with traditional mastectomy. Results The tumor size ranged from 30 mm to 55 mm before neoadjuvant chemotherapy, and ranged from 25mm to 45 mm after neoadjuvant chemotherapy. The median weight of the tumor specimens in breast conservative operation was 140 g (90 g to 220 g). A-mong the 18 patients, 16 cases had more than 3 scores with satisfied cosmetics (93.33 % ). Dorsal subcu-taneous seroma in donation area was observed in 5 of 18 patients (27.78 %) and dorsal incision dehiscence was observed in 2 of 18 patients (11.11%). None of the patients developed recurrence except that 1 pa-tient (5.55 %) had distance metastasis (bone metastasis} in a mean 22-months follow-up. The Kaplan-Meier survival curve in breast conservation reconstruction patients had no different from that of traditional mastectomy patients at the same time. Conclusions Immediate conservative breast surgical reconstruction by using the same lateral latissimus dorsal myocutaneous flap is an effective method for stage Ⅱ and stage Ⅲ breast cancer patients combined with neoadjuvant chemotherapy, which can increase satisfactory breast so that cosmetic outcome can be reached.

The Efficacy of Enoxaparin for the Prevention of a Pulmonary Thromboembolism in a Skin-sparing Mastectomy with Immediate Reconstruction in Breast Cancer / 한국유방암학회지

PURPOSE: Performance of a skin-sparing mastectomy with immediate reconstruction provides psychological satisfaction and good cosmetic outcome for patients with breast cancer. However, this is a lengthy procedure to perform, and there is increased risk of pulmonary thromboembolism (PTE). The purpose of this study was to evaluate the efficiency of the use of low molecular weight heparins (enoxaparin) for prophylaxis against a pulmomary thromboembolism followed by mastectomy with an immediate transverse rectus abdominis myocutaneous flap (TRAM) in breast cancer. METHODS: A total of 123 patients underwent a skin-sparing mastectomy with an immediate TRAM. The "non-enoxaparin group" wore compression stockings for PTE prophylaxis and the "enoxaparin group" received enoxaparin (40 mg SC injection, once daily starting 2 hr before surgery and continuing for 6 days postoperatively) in conjunction with the use of compression stockings. Lung perfusion, inhalation scans, and serum D-dimer assays were performed on postoperative day 3. If findings were clinically suspicious or intermediate to high probability of a PTE in a lungs scan, embolism computed tomography was performed. Patients were prospectively investigated according to the clinicopathological data. We compared the incidence of PTE and hemorrhagic complications between the two groups. RESULTS: There were no significant clinicopathological differences between the two groups. Eleven patients developed a PTE (nine patients in the non-enoxaparin group and two patients in the enoxaparin group). The prevalence rate of a PTE was 17.3% and 3.2% for each group, respectively (p=0.01). One patient in the non-enoxaparin group required a second operation for bleeding control and three patients in the enoxaparin group needed transfusions. There were minor hemorrhagic complications in the enoxaparin group that improved after supportive management. CONCLUSION: Although there were minor hemorrhagic complications, enoxaparin is safe and effective in a preventing PTE in patients that undergo immediate reconstruction after a skin-sparing mastectomy.

Pulmonary Thromboembolism following Mastectomy with Immediate TRAM in the Patients with Breast Cancer : a Prospective Study / 한국유방암학회지

PURPOSE: : Skin-sparing mastectomy with immediate reconstruction provides psychological satisfaction and a good cosmetic effect for patients with breast cancer. However, this procedure takes longer operation time than mastectomy, and the risk of pulmonary thromboembolism (PTE) and deep vein thrombosis may be increased. The purpose of this study was to evaluate the incidence of PTE. METHODS: Between January and May in 2005, 54 breast cancer patients who underwent skin-sparing mastectomy with immediate transverse rectus abdominalis myocutaneous flap (TRAM) at Asan Medical Center were prospectively investigated according to the clinicopathologic data. Patients were placed in compression stockings on the day of operation, and lung perfusion, inhalation scans,and serum D-dimer assays were performed on the first three postoperative days. If findings were suspicious, we performed embolism computed tomography. We compared patient age, body mass index (BMI), clinical risk factors, operative findings, pathologic results, and the clinical course between PTE patients and non-PTE patients. RESULTS: There were 9 cases of intermediate probability and 6 cases of high probability for PTE according to lung perfusion and inhalation scans, and they underwent embolism CT. Eleven patients (20.4%) were diagnosed with embolism CT or with lung perfusion and inhalation scans;2 patients were symptomatic and 9 patients were asymptomatic. There was significant difference between PTE and non-PTE patients for age, but none for BMI, clinical risk factors, operation time, serum D-dimer, or stage. CONCLUSION: The incidence of PTE after mastectomy with immediate TRAM is relatively high, and a strategy for the prevention and treatment of PTE is required. Although age is a risk factor for PTE on this study, future studies are needed to determine the risk factors for and to confirm proper treatment and prevention of PTE.

Recurrence and Survival Analysis in Skin-Sparing Mastectomy with Immediate Reconstruction Compared with Conventional Mastectomy / 한국유방암학회지

PURPOSE: A skin-sparing mastectomy (SSM), followed by immediate reconstruction, which has aesthetic advantages, is being increasingly used to treat many early breast carcinomas; however, there are few data regarding the outcome and safety of this procedure. The objective of this study was to evaluate the safety of utilizing a SSM with immediate reconstruction compared with the outcome of a conventional mastectomy. METHODS: A retrospective review was performed on 169 patients who underwent a SSM with immediate reconstruction, and 2102 patients who received a conventional mastectomy between January 1996 and December 2002, at the Asan Medical Center. The patient and tumor characteristics, as well as the types of reconstruction, incidences of recurrence and survival rates were examined. RESULTS: The mean age of the SSM group was younger (39 vs. 47 years, p < 0.001), and the mean tumor size smaller than those of the mastectomy group (2.6 vs. 3.2cm, p = 0.002). Lymph node involvement was present in 39.6% and 48.4% of the SSM and mastectomy groups, respectively (p = 0.24). The proportion at early stages (0 and 1) in the SSM group was higher than those in the mastectomy group (50.9 vs. 30.7%, p < 0.001). In the high-risk patients, postoperative radiation was administered to 24.1 and 54.9% of the SSM and mastectomy group, respectively (p = 0.002). With a median follow-up of 41 months, the recurrence rates for the SSM and mastectomy groups were 11.8 (20 of 169 patients) and 14.4% (303 of 2102 patients), respectively (p = 0.22). There were no differences in the locoregional and distant recurrences between the two groups. The 5-year disease free survivals for the SSM and mastectomy groups were 81.9 and 81.7%, respectively (p = 0.71). The 5-year overall survivals for the SSM and mastectomy groups were 91.7 and 88,8%, respectively (p = 0.13). In a univariate analysis, the factors associated with a recurrence and the survival rates were the tumor stage and a lymph node positive state. CONCLUSION: No significant differences were found in the recurrence and survival rates of the SSM group, with immediate reconstruction, compared to those of the mastectomy only group. A skin-sparing mastectomy, with immediate reconstruction, which has greater aesthetic benefits, appeared to be an oncologically safe treatment option for breast carcinomas.

Endoscopic Subcutaneous Mastectomy and Immediate Reconstruction of Breast Cancer / 한국유방암학회지

PURPOSE: A subcutaneous mastectomy has been proven to be oncologically safe for early breast cancer. Although a subcutaneous mastectomy and reconstruction are well established, most incisions are made directly on the breast. To improve the cosmetic outcome, an endoscopic subcutaneous mastectomy and immediate reconstruction was undertaken, which can be performed through minimal axillary and periareolar semicircular incisions. METHODS: Between October 2002 and December 2003, 9 patients with early breast cancer, whose tumors were less than 4 cm in size and more than 2 cm-apart from the nipple-areolar complex, and who were clinically node negative without invasion to skin and pectoralis muscle, underwent 10 endoscopic subcutaneous mastectomies with immediate reconstruction employing saline bag implants. Firstly, an endoscopic dye-guided sentinel node biopsy was performed through a low transverse axillary incision lateral to the pectoralis major. A subpectoral pocket was gently created under the view of endoscopic monitor by Vein Harvest. A periareolar semicircular incision was made to create the skin flap using Visiport and PowerStar Scissors. Frozen section biopsies were performed to rule out tumor invasion to the resection margin. After resection of the entire breast tissue, a saline bag prosthesis was inserted. The patients and tumor characteristics, operation times, amounts of bleeding, and cosmetic results were evaluated. RESULT: The mean patient age was 45 years (25~55). The mean tumor size was 2.5 cm, ranging from 0.7 to 5.0cm. The average operation time was 112 minutes (80~150). The mean amounts of operative bleeding was 232 ml. There was one case of transient necrosis of the nipple-areolar complex. An early implant removal was performed in one patient due to a suspected microperforation. Excellent or good cosmetic results were obtained in 8 patients (88.8%). CONCLUSION: An endoscopic subcutaneous mastectomy with immediate reconstruction, is a new technique that can minimize the direct operation scar on the breast skin following a classic operation. In properly selected cases, our results show maximized cosmetic satisfaction of breast cancer patients, so offers a promising alternative to a classic subcutaneous mastectomy with immediate reconstruction.

Skin-sparing Mastectomy with Immediate Breast Reconstruction for the Treatment of Advanced Breast Cancer / 한국유방암학회지

PURPOSE: This study was performed to show the several clinical variables before and after the surgery that need to be considered for patient selection and whether there is an increased possibility of recurrence after surgery and whether this possibility can be reduced when adjuvant treatment is applied. METHODS: The outcome of SSM with immediate breast reconstruction, using follow-up data of cases performed at Asan Medical Center between September, 1996 and December, 2002, were retrospectively assessed and pathologically advanced breast cancer patients (stage III) were analyzed separately. RESULTS: 191 patients had undergone SSM with immediate reconstruction during the study period. The percentage of cases stage III was 15.2% (29 cases). Among these patients, 6 (20.7%) were suspected of being in the early stages of breast cancer prior to the surgery. The mean age of the advanced breast cancer patients was 37 years. Immediate breast reconstruction consisted of a pedicled TRAM flap (n=24), a insertion of tissue expander (n=4) or direct implant (n=1). Radiotherapy was performed in 16 patients (53.3%) and chemotherapy was conducted without delay in all case. With a median length of follow-up of 36.1 months for 22 patients, who under went the operation until December, 2001, local recurrence was 4.5% (1/22) with successful local treatment, and distant metastasis was 13.7% (3/22). There was no difference in the disease free survival compared to that of the non-reconstruction group (P=0.093). CONCLUSION: SSM with immediate reconstruction seems safe and effective for patients with advanced breast cancer. However an accurate preoperative assessment of the extent of the disease and discussion for the planning of treatment between surgeon and patient is required.

Immediate Reconstruction of Defects Caused by Mohs Surgery of Skin Cancer / 대한피부과학회지

BACKGROUND: Mohs surgery is an increasingly appealing option for skin cancer. It is traditionally performed by a Mohs dermatologist, followed by a secondary repair by a head and neck or plastic surgeon. But one-stage procedure Mohs surgery with immediate reconstruction enhances patient's satisfaction and reduces the need for more than one procedure or multiple postoperative visits. OBJECT: The purpose of this study was to report our experience of Mohs surgery and immediate reconstruction by a dermatologist. Results, complications, and recurrence rates were reviewed. METHODS: Seventy five skin cancers, which were treated by Mohs surgery and reconstructed immediately were analysed retrospectively. RESULT: There were 43 females and 32 males. The mean age was 62.2. Basal cell carcinoma was the most common skin tumor. The Nose was the most common anatomic site. The mean size of tumor was 1.8cm. The local flap was the most common used to repair surgical defects. Complications were minimal. Recurrent cases were none during 40-months follow up (range, 12-58 months). CONCLUSION: Immediate one-stage reconstruction after Mohs surgery by a dermatologist is a safe, convenient method to treat skin cancers.

Immediate Breast Reconstruction Following Mastectomy for the Treatment of Advanced Breast Cancer Patients

PURPOSE: To elucidate whether there is a delay of adjuvant treatment or detection of recurrences, or an increasing of the recurrence of tumorsin clinically advanced breast cancer patients. METHODS: The study group included 55 patients underwent mastectomy with immediate reconstruction (IBR), and 563 patients who received the mastectomy without reconstruction (non-IBR), and who were stage IIB and IIIA breast cancer patients, at Asan Medical Center between Jun 1993 and December 2000. We retrospectively assessed the comparative outcomes through using follow-up data. RESULTS: Out of 2,057 patients who had undergone the mastectomy on during the period, 175 (8.5%) underwent immediate reconstruction. 55 of them (31.6%) were stage IIB and IIIA patients, a similar portion (29.9%) was seen in the 563 patients of same stages without reconstruction. The mean ages of these groups were 37.1 and 46.9 years, that is, the reconstruction group was about 10 years younger. All these patients voluntarily underwent immediate reconstruction. For the patients who were followed up, the local recurrence was 3.6% (2/55) for the IBR group and 5.2% (29/563) for the non-IBR group. On the other hand, the distant relapse rates were 12.7% and 13.9%. The administration of adjuvant chemotherapy was not delayed and radiotherapy was used as an adjuvant treatment after reconstruction in nine of the cases (16.4%). Chemotherapy was also conducted in 98.2% of the IBR group and 77.3% of the non-IBR group. While radiotherapy was used in the IBR group less frequently, there was no statistical difference between the two groups (P=0.63). CONCLUSION: Immediate reconstruction following mastectomy for the treatment of breast cancer is now more frequently performed. IBR can be done in clinically advanced breast cancer without increasing the risk of treatment failure or modification.

Skin Sparing Mastectomy with Circumareolar Incision and Immediate TRAM and One-Stage Star Flap Nipple-Areolar Complex Reconstruction / 한국유방암학회지

BACKGROUND: Breast reconstruction after a mastectomy is being performed in many cases by using a tissue expander or a TRAM flap. However, a conventional mastectomy leaves long linear scar formation on the breast skin after reconstruction. A skin-sparing mastectomy (SSM) with one-stage star flap nipple-areolar complex immediate reconstruction makes minimal scar tissue, and with a circumferential incision is made around the nipple, becoming virtually imperceptible. The purpose of this study is to identify the clinical indications, to evaluate the clinical results, and to encourage the application of thins method for the indicated patients. MATERIALS AND METHODS: During the recent 3 years, 1996 through 1999, there were 1027 breast-cancer surgeries. Among them, there were 61 reconstruction cases, a skin-sparing mastectomy (SSM) with immediate reconstruction was performed on 29 cases. Of these patients, 15 patients were taken SSM and TRAM flap reconstruction. Our patients selection criteria of SSM was as follows, diffuse DCIS that not candidates for breast conserving surgery, Paget's disease of the nipple, clinically early breast cancer without skin involvement, and the centrally located cancer that would require removal of the nipple-areolar complex. RESULTS: All the surgeries performed under these procedures were considered to be successful. All of the TRAM flap and star flap were alive. The main rawback was bleeding, which occurred in 6 patients but was managed by transfusion. The wound seroma occurred in 3 patients and was managed easily by repeated aspiration. CONCLUSIONS: Skin-sparing mastectomy with immediate TRAM and star flap reconstruction gives markedly improved results by reducing the scars on the reconstructed breast, providing a supple breast with a natural ptotic shape, and aesthetically satisfied. We propose more frequent application of this method for the indicated patients, but we need further follow-up of the local recurrence rate and the detection rate in these patients.

Subcutaneous Mastectomy with Immediate Reconstruction as Treatment for Early Breast Carcinomas

BACKGROUND: Breast-conservation surgery is now widely used, but is inappropriate in some patients with high risk of recurrence and in patients who refuse radiation therapy. A number of women who undergo a mastectomy in these circumstances request reconstruction. Recently, subcutaneous mastectomies have been performed through an inframammary incision or incision down the lateral side of the breast. The purpose of the present study was to determine the cosmetic results and the complications after a subcutaneous mastectomy using a newly designed skin incision and immediate reconstruction. METHODS: Subcutaneous mastectomies with immediate reconstruction were performed in 17 patients with early breast cancer from June 1997 to November 1998. The inclusion criteria for this procedure were a peripherally located tumor, a size smaller than the T2 size, clinically negative axillary lymph nodes, and a grossly normal nipple and areolar area. A radial skin incision from the lateral edge of the areolar or an incision down the lateral side of the breast with or without an axillary incision was performed, depending on the location of the tumor. If two or more metastatic nodes among 5 or 6 nodes were confirmed by frozen biopsy, we planned a delayed reconstruction. To avoid nipple-areolar recurrence, we performed a frozen biopsy of the resection margin. RESULTS: The mean age of the patients was 38, and the majority of tumors were invasive ductal tumors (9 cases) and DCIS tumors (5 cases). All of the tumor sizes were less than 3 cm (T1: 10 cases, T2: 7 cases). All of the tumors were stage 0 to stage 2 at the time of operation. Thirteen permanent saline-filled protheses, two tissue expanders, one conventional flap, and one free TRAM flap were used for reconstruction. Immediate postoperative complications were 4 case of transient ischemic necrosis of the nipple- areolar area, one case of complete necrosis of the nipple-areolar area, and three case of transient focal skin necrosis. Three of these patients had both transient ischemic necrosis of the skin and the nipple- areolar area. Loss of touch sensation in the central portion of breast occurred in all cases. The majorcosmetic problems were 4 cases of asymmetric breasts and 2 cases of nipple displacement, which was more common in patients with a ptotic breast and in patients who had received a skin incision through the lateral edge of the breast. Excellent or good cosmetic results were obtained in 75% of the patients. There was no local recurrence, but the follow up was short term (mean follow-up period: 12 months). A radial skin incision, with or without axillary incision, was more cosmetic and more easily and completely dissected the breast parenchymal tissue than a lateral incision of the breast was. CONCLUSION: These results support the use of this technique in the treatment of early breast cancer.

Skin-sparing Mastectomy with Circumareolar Incision and Immediate Reconstruction in Breast Cancer / 한국유방암학회지

BACKGROUND: Now, breast reconstruction is being performed in many cases after mastectomy by using tissue expander or TRAM flap. But conventional mastectomy leaves a long linear scar tissue which is also seen on the breast skin after breast reconstruction. Skin spring mastectomy with immediate reconstruction leaves a minimal scar tissue, even though, with circumareolar incision, it makes no visible scar tissue. PURPOSE: The purpose of this study is 1) to identify the clinical indications for Skin-spring mastectomy (SSM) with immediate reconstruction, 2) to evaluate the clinical results and 3) to encourage the application of this method. MATERIALS AND METHODS: During recent 20 months, breast cancer surgery were 467 cases, mastectomy were 368 (78.8%, 368/467), mastectomy with breast reconstruction were 30 case (8.2%, 30/368), Among 30 reconstruction cases, Skin-spring mastectomy (SSM) with circumareolar incision and immediate reconstruction were performed in 9 patient. Our patient selection criteria was as follows; 1) patient's desire of reconstruction on cosmetic aspect 2) clinically early breast cancer 3) moderate breast size 4) central locating tumor 5) no Skin involvement. RESULTS: 1) we performed 9 cases of Skin-spring mastectomy (SSM) with circumareolar incision and immediate reconstruction. 2) Three patient who complainted palpable mass were diagnosed by FNA for breast cancer and the other 6 patient were proved by ductal biopsy in 4 cases whose complaint was bloody nipple discharge, a H-wire biopsy in whose mammography revealed multiple microcalcifications and a punch biopsy in whose nipple was eczematous. All cases were suspected for early breast cancer preoperatively. 3) Four cases were stage 0, 3 cases were stage I lesions and 2 cases were stage III in postoperative pathologic staging. 4) All the patients were satisfied with their cosmetic results. CONCLUSIONS: Skin-spring mastectomy (SSM) with immediate reconstruction is new method for breast cancer operation with modified skin incision and shows good aesthetic results. we propose more frequent application of this method for indicated patient, but we need futher follow-up of local recurrence rate and detection rate in these patients.

Skin-Sparing Mastectomy with Circumareolar Incision and Immediate Reconstruction in Breast Cancer

BACKGROUND : Now, breast reconstruction after a mastectomy is being performed in many cases by using a tissue expander or a TRAM flap. However, a conventional mastectomy leaves long linear scar tissue which is also seen on the breast skin after breast reconstruction. A skin-sparing mastectomy with immediate reconstruction leaves minimal scar tissue, and with a circumareolar incision, it leaves no visible scar tissue. Purpose : The purpose of this study is (1) to identify the clinical indications for a skin-sparing mastectomy with immediate reconstruction, (2) to evaluate the clinical results, and (3) to encourage the application of this method. METHODS : During the recent 20 months, there were 467 breast-cancer surgeryes : 368 metastectomes (78.8%, 368/467), and 30 mastectomes with breast reconstruction (8.2%, 30/368), Among the 30 recon struction cases, a skin-sparing mastectomy with a circumareolar incision and immediate reconstruction was performed on 9 patients. Our patient selection criteria was as follows : (1) patient's desire for recon struction from a cosmetic aspect, (2) clinically early breast cancer, (3) moderate breast size, (4) centrally located tumor, and (5) no skin involvement. RESULT : 1) We performed 9 skin-sparing mastectomies with a circumareolar incision and immediate reconstruction. 2) Three patient who complained of a palpable mass were diagnosed by FNA as having breast cancer. In the other 6 patient, the cancer was diagnosed by a ductal biopsy in 4 cases where the complaint was a bloody nipple discharge, by a H-wire biopsy in one case where mammography re vealed multiple microcalcifications, and by a punch biopsy in one case where the nipple was eczematous. Preoperatively, cases were suspected of having early breast cancer. 3) Four cases were stage 0, 3 cases were stage I, and 2 cases were stage III in postoperative pathologic staging. 4) All the patients were satisfied with their cosmetic results. CONCLUSION : A skin-sparing mastectomy with immediate reconstruction is a new method for breast cancer surgery with modified a skin incision and shows good aesthetic results. We propose more frequent application of this method for the indicated patient, but we need further follow-up of the local recurrence rate and the detection rate in these patients.