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

ABSTRACT

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.