Conservative mastectomy: Extending the idea of breast conservation

Scientific Direction, European Institute of Oncology, Milan, Italy.
The Lancet Oncology (Impact Factor: 24.69). 07/2012; 13(7):e311-7. DOI: 10.1016/S1470-2045(12)70133-X
Source: PubMed


Conservative mastectomy is a surgical technique to remove breast glandular tissue without disruption to the appearance of the breast. The main contraindication to this operation is involvement of the nipple-areola complex. Preservation of a healthy nipple does not affect long-term survival rates. Intraoperative retroareolar biopsy and accurate removal of all mammary tissue are mainstays to guarantee oncological safety of the technique. A complication, however infrequent, is nipple necrosis, which can be treated successfully by local excision. Several breast reconstructive techniques are used during conservative mastectomy and aesthetic results are good in most cases.

50 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Tailored therapy for breast cancer with conservation of uninvolved tissue is becoming increasingly important, especially as the benefits of breast reconstruction are recognized. Preservation of the nipple areolar complex during mastectomy is emerging as a viable option in selected patients. Technical considerations for prevention of adverse outcomes such as nipple necrosis are reviewed, along with implications for reconstructive method and outcomes. Finally, the oncologic efficacy of nipple-sparing mastectomy is discussed in the context of occult nipple disease and local recurrence. Standardization of technique, optimization of aesthetic outcome, and examination of long-term prognosis represent future areas of development.
    Current Breast Cancer Reports 06/2013; 5(2). DOI:10.1007/s12609-013-0107-y
  • [Show abstract] [Hide abstract]
    ABSTRACT: Over time, surgical techniques have advanced to the point where oncological safety and aesthetic outcomes are the pillars of contemporary breast surgery. Variations of mastectomy came up and started allowing the oncological safety and the possibility of an immediate breast reconstruction. Nowadays the association between plastic surgical techniques and mastectomy with immediate breast reconstruction is one of the best alternatives to treat breast cancer and also improved overall aesthetic outcomes and favors the achievement of contralateral breast symmetry. "Oncoplastic mastectomy" is a feasible term and can be routinely used.
    05/2013; 2(2):102-6. DOI:10.3978/j.issn.2227-684X.2013.05.03
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Immediate breast reconstruction with an expander-implant is an alternative in breast cancer surgery in patients requiring mastectomy. The objective of this study was to analyze the welfare impact of this procedure and its effectiveness in breast reconstruction. Patients and method The study group consisted of patients treated for breast cancer who underwent mastectomy and immediate reconstruction with an expander-implant. All patients were treated by a single surgeon between January 2009 and December 2012. We excluded all patients with delayed or autologous reconstruction and prophylactic mastectomy. The variables analyzed were age, operating time, length of hospital stay, delayed initiation of chemotherapy, complications, reoperations, histopathologic features of the tumor, and lymph node involvement. These variables were compared in a prospective non-randomized study with those in a control group consisting of patients who underwent conservative surgery or mastectomy without reconstruction. Results There were 69 patients in the study group and 312 patients in the control group. Comparison between the study and the control group showed no significant differences in healthcare delays, the start of adjuvant therapy, or postoperative complications, but differences were found in operating time and length of hospital stay. Expansion was completed in 61 patients (88.4%) and breast reconstruction in 53 (76.8%). Analysis by treatment groups showed that greater procedural success was achieved in patients without adjuvant treatments (100%), while patients with chemotherapy and radiotherapy had the lowest success rate (80%). Conclusion Immediate breast reconstruction with an expander-implant requires longer operating time and hospital stay than other techniques in breast oncology. Most patients will successfully complete the reconstructive process, but the failure rate will be higher in irradiated patients.
Show more