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.

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.