[One stage skin-sparing breast repair after mastectomy]. / Odnomementnaia rekonstruktsiia molochnoi zhelezy posle mastéktomii s sokhraneniem kozhi.

Breast-conserving therapy has become very popular in the past 20 years. This treatment is beneficial only for early stages of breast cancer. When breast-conserving therapy is not indicated, skin-sparing mastectomy with immediate breast reconstruction using silicone implants or autogenous tissue is the surgical method of choice. The authors have analyzed the results obtained at three hospitals of Moscow, Novosibirsk, and Tula. A total of 58 breast repairs, including 23 with silicone expanders, 35 with TRAM-flaps were performed by February 2000. They accomplished different designs of skin incisions in relation to the size and site of a tumor and to the shape of the breast. These groups comprised patients with breast cancer T1-2No-1Mo. The follow-up averaged 25.8 months (range 5-52 months). All the patients underwent combined and complex treatments. The median of overall survival was not not achieved. One patient died from dissemination. Two-year acturial survival was 86.8% (one local recurrence). The incidence of postoperative complications was 34.7% in the implant group and 14.2% in the TRAM-flap group.

[One-stage reconstruction of the breast after mastectomy with skin preservation]. / Odnomomentnaia rekonstruktsiia molochnoi zhelezy posle mastéktomii s sokhraneniem kozhi.

Our experience points to the advantages of preserving a cutaneous flap remaining after mastectomy followed by one-stage reconstruction using a recto-abdominal flap of silicone expanders and endoprostheses. The procedures used provided for removal of the halo-papillary complex, skin scarred by biopsy, the entire mammary gland tissue with the subaxillary, subclavicular and subscapular lymph nodes. The epithelium was removed from the recto-abdominal flap which was placed into a cutaneous pouch after mastectomy. A small round piece of the flap skin replaced the defect caused by halo removal. As a result, both breasts were practically symmetrical and identical in volume. When silicone implants are used, the skin pouch is filled with an expander installed under musculus pectoralis major. Since October, 1995, 26 such operations have been carried out.