Breast Cancer after Augmentation Mammaplasty: Treatment by Skin-Sparing Mastectomy and Immediate Reconstruction

ArticleinPlastic & Reconstructive Surgery 107(3):687-92 · April 2001with16 Reads
DOI: 10.1097/00006534-200103000-00006 · Source: PubMed
Breast conservation has been associated with poor cosmetic outcome when used to treat breast cancer in patients who have undergone prior augmentation mammaplasty. Radiation therapy of the augmented breast can increase breast fibrosis and capsular contraction. Skin-sparing mastectomy and immediate reconstruction are examined as an alternative treatment.Six patients with prior breast augmentation were treated for breast cancer by skin-sparing mastectomy and immediate reconstruction. One patient underwent a contralateral prophylactic skin-sparing mastectomy. Silicone gel implants had been placed in the submuscular location in five patients and in the subglandular position in one patient a mean of 10.2 years (range, 6 to 20 years) before breast cancer diagnosis. The mean patient age was 41.3 years (range, 33 to 56 years). Four independent judges reviewed postoperative photographs to grade the aesthetic results in comparison with the opposite native or reconstructed breast. The American Joint Committee on Cancer staging was stage 0 in one patient, stage I for four patients, and stage II for one patient. Five of the six patients presented with a palpable breast mass. Latissimus dorsi flap reconstruction was performed in four patients (bilaterally in one) and a transverse rectus abdominis muscle (TRAM) flap was used in two patients. Three patients were treated by skin-sparing mastectomy with preservation of the breast implant (two patients with latissimus flaps, and one patient with a TRAM flap). The tumor location necessitated the removal of implants in two patients (one patient with a latissimus flap and one with a TRAM. A saline implant was placed under the latissimus flap after gel implant removal. The patient who underwent bilateral skin-sparing mastectomies desired explantation and placement of saline implants. No remedial surgery was performed on the opposite breast to achieve symmetry. Complications occurred in two patients at the latissimus dorsi donor site (seroma in one patient, and seroma and infection in one). Five patients underwent complete nipple reconstructions. The mean duration of follow-up was 33.6 months (range, 15.5 to 70.3 months), and there were no recurrences of breast cancer. The aesthetic results were judged to be good to excellent in all cases.Skin-sparing mastectomy and immediate reconstruction can be used in patients with prior breast augmentation, with good to excellent cosmetic results. Depending on the tumor and implant location, the implant may be preserved without compromising local control.
    • "The development of skin-sparing mastectomy (SSM) with immediate reconstruction achieved the goal of radical excision of the tumor with improved cosmetic outcome. In addition, the overall survival and local recurrence rates were similar to cases of modified radical mastectomy (Carlson et al, 2001;). The main oncological concern in both SSM and non-skin sparing mastectomy (NSSM) relates to the possibility of leaving residual tumor within the skin envelope which may manifest later as local recurrence (LR). "
    [Show abstract] [Hide abstract] ABSTRACT: Background The development of SSM & NSM with immediate breast reconstruction achieved the goal of radical excision of the tumor with improved cosmetic outcome. Immediate autologous breast reconstruction yields the most durable and natural appearing results with the greatest consistency. The aesthetic results from autologous reconstruction are superior to those of implant based reconstruction due to their versatility, their more natural appearance, consistency and durability. Moreover, autologous tissue can better withstand radiotherapy. Patients & Methods In our series; five hundred & seventy patients of stage I to III breast carcinoma have autologous breast reconstruction with modified extended LDF with added vascularised chest wall fat; 47% had SSM and the remaining had NSM. Age ranges from 23 to 63 years (median = 40.5). Results Subjective patient satisfaction was excellent in 71%, good in 20%, fair in 7% & poor in 2% of cases. Bilateral size & shape symmetry are excellent in 56%, good in 26%, fair in 12% & poor in 6% patient. Patients are followed for mean follow up of 75.5 months (6-96). Conclusion Modified extended latissimus dorsi myocutaneous flap with added vascularised chest wall fat is a single stage totally autologous breast reconstruction allows reconstruction without the additional cost of an implant, many complications of synthetic implants, micro vascular procedure second stage surgery or surgical manipulation in the other breast. In addition the overall survival & local recurrence rates were similar to MRM.
    Full-text · Chapter · Feb 2012
    • "Indications for skin-sparing mastectomy are BRCA1/2 mutation, intraepithelial neoplasia (DIN or LIN), particularly when the lesion is extensive, multicentric or recurrent, and early-stage breast cancer for which breast-conserving therapy is not suitable [63]. Some of studies support the use of skin-sparing mastectomy following neoadjuvant treatment, for recurrence after breast-conserving surgery, and malignancy after additive mammoplasty646566. Skin involvement by the tumour is an absolute contraindication for skin-sparing mastectomy. "
    [Show abstract] [Hide abstract] ABSTRACT: Breast cancer is the most common cancer in women. Primary treatment is surgery, with mastectomy as the main treatment for most of the twentieth century. However, over that time, the extent of the procedure varied, and less extensive mastectomies are employed today compared to those used in the past, as excessively mutilating procedures did not improve survival. Today, many women receive breast-conserving surgery, usually with radiotherapy to the residual breast, instead of mastectomy, as it has been shown to be as effective as mastectomy in early disease. The relatively new skin-sparing mastectomy, often with immediate breast reconstruction, improves aesthetic outcomes and is oncologically safe. Nipple-sparing mastectomy is newer and used increasingly, with better acceptance by patients, and again appears to be oncologically safe. Breast reconstruction is an important adjunct to mastectomy, as it has a positive psychological impact on the patient, contributing to improved quality of life.
    Full-text · Article · Jun 2011
    • "et al. 1999; Foster et al. 2002; Downes et al. 2005) Numerous other studies have analyzed the recurrence rates after SSM and IBR, however, due to the short history of skin-sparing mastectomy, the follow-up times tend to be rather short in many of these studies. (Noone et al. 1994; Newman et al. 1998; Slavin et al. 1998; Kroll et al. 1999; Ringberg et al. 1999; Simmons et al. 1999; Toth et al. 1999; Rivadeneira et al. 2000; Carlson et al. 2001; Stradling et al. 2001; Foster et al. 2002; Medina-Franco et al. 2002; Carlson et al. 2003; Langstein et al. 2003; Spiegel and Butler 2003; Fersis et al. 2004; Downes et al. 2005; Greenway et al. 2005) The present study presents a 10-year series of 207 SSM and IBR patients and a 15-year series of 146 patients with Stage I or II disease, giving a reasonably good image of both the complications involved with the operation and the recurrence rates for different stages. Surgical complications of SSM have been reviewed in a few previous studies . "
    [Show abstract] [Hide abstract] ABSTRACT: Breast cancer is the most common form of potentially fatal cancer in women in the Western world. Better understanding of the breast cancer disease process together with developments in treatments have led to improved survival and reduced risk of recurrence, significantly influencing the acceptance of breast reconstructions as part of breast cancer treatment. Skin-sparing mastectomy followed by immediate breast reconstruction has proved superior to other forms of breast reconstruction in terms of aesthetic outcome. However, due to the relatively recent introduction of skin-sparing mastectomy concerns on the surgical and oncological safety of the operation persist. The aim of the present study is to evaluate the surgical and oncological safety of skin-sparing mastectomy and immediate breast reconstruction in a consecutive patient series with ensuing follow-up. Subsequent aims of the study are to examine possibilities of reducing surgical complications of the operation and to assess the feasibility of sentinel node biopsy together with immediate breast reconstruction. The study population comprises a consecutive series of patients having undergone skin-sparing mastectomy followed by immediate breast reconstruction at the Helsinki University Central Hospital between 1992 and 2006. In Study I, the hospital records of 207 patients, operated between 1992 and 2001, were analyzed for surgical complications and recurrences of breast cancer during follow-up. In Study II, 60 consecutive patients were randomized into either conventional diathermy or radiofrequency coagulation groups to examine possibilities of reducing skin-flap complications. Study III consists of 62 consecutive breast cancer patients evaluated for the feasibility of sentinel node biopsy simultaneously with immediate breast reconstruction. In Study IV, hospital records were analyzed to examine local recurrence of breast cancer in a consecutive series of 146 patients with Stage I or II disease. Post-operative complications in Study I included native skin-flap necrosis (10.1%), hematoma (10.1%), anastomose thrombosis (5.3%), infection (3.4%), hernia (2.6%) and loss of one microvascular flap (0.7%). The Stage I and II patients in Study IV had a local recurrence rate of 2.7%, an isolated regional lymph node recurrence rate of 2.1% and a systemic recurrence rate of 2.7%, during a mean follow-up time of 51 months. The Stage III patients in study I had a locoregional recurrence rate of 31.3% during follow-up. Radiofrequency coagulation in Study II did not decrease skin-flap complications when compared with conventional diathermy. An increased skin-flap complication rate in Study II was associated with smoking and the type of skin incision used. In Study III, eleven patients had tumor positive sentinel nodes, nine of which were detected intraoperatively. Skin-sparing mastectomy followed by immediate breast reconstruction is a safe procedure both surgically and oncologically, especially for early stage breast cancer. Tennis racket type incision is associated with an increased skin-flap complication rate. Sentinel node biopsy with intraoperative assessment of sentinel node metastases is feasible in patients undergoing immediate breast reconstruction. Rintasyöpä on naisten yleisin syöpä länsimaissa Suomessa rintasyöpään sairastuu vuosittain yli 4000 naista, joista puolet alle 65-vuotiaina. Enemmistö rintasyöpäpotilaista paranee nykyisin sairaudestaan ja kuolleisuus on vähentynyt alle 20 prosenttiin. Hoidettavien ja hoidettujen potilaiden määrän kasvaessa hoidon vaatimien resurssien ja toisaalta hoidon jälkeisen elämänlaadun merkitys kasvaa. Rintasyövän hoito on kehittynyt huimasti viime vuosikymmeninä, mutta syövän kirurginen poisto on säilyttänyt asemansa rintasyövän hoidon kulmakivenä. Rintasyöpäkirurgia on kehittynyt vuosien mittaan kudoksia säästävämpään suuntaan ja kirurgisen hoidon esteettiseen lopputulokseen kiinnitetään lisääntyvää huomiota. Useissa tutkimuksissa onkin osoitettu hyvän esteettisen lopputuloksen merkitys psykososiaalisen sairastuvuuden vähenemiselle. Rinnan kirurginen poistaminen on edelleen välttämätöntä monissa rintasyöpätyypeissä, mutta rinnan myöhäisrekonstruktioiden sijaan uusi rinta voidaan nykyisin usein rakentaa välittömästi rinnanpoiston yhteydessä, jos potilas rekonstruktiota toivoo. Tällöin esteettisesti optimaalinen tulos on saavutettavissa ihoa säästävällä rinnanpoistolla ja välittömällä rekonstruktiolla omista kudoksista muodostettavan siirteen avulla. Tarvittaessa rekonstruktiossa voidaan lisäksi käyttää silikoniproteesia. Välitön rekonstruktio rinnanpoiston yhteydessä on myös taloudellisesti ja inhimillisesti ylivertainen menetelmä myöhäisrekonstruktioon verrattuna, sillä potilas selviää kahden suuren leikkauksen sijaan yhdellä ja säästöä syntyy niin sairaalahoidon pituudessa, leikkauskapasiteetissa kuin sairaslomien pituudessakin. Rintarekonstruktioleikkaukset ovat kuitenkin herättäneet kiivasta keskustelua niiden syövänhoidollisista vaikutuksista. Rintarekonstruktioiden on pelätty lisäävän rintasyövän paikallisen uusiutuman riskiä tai peittävän alleen ja hidastavan uusiutuman havaitsemista. Erityinen huoli on liittynyt ihoa säästävään rinnanpoistoon, sillä on epäilty, että ihon säästäminen lisäisi paikallisen uusiutuman vaaraa. Tässä väitöskirjatutkimuksessa on tutkittu ihoa säästävän rinnanpoiston kirurgista ja syövänhoidollista turvallisuutta laajassa potilasaineistossa, joka käsittää kaikki HYKS:ssä vuosina 1992-2006 leikatut yli 400 rintasyöpäpotilasta, joille on tehty välitön rintarekonstruktio. Väitöstutkimus osoittaa välittömän rintarekonstruktion olevan kirurgisesti turvallinen toimenpide, jonka jälkeiset vakavat komplikaatiot ovat harvinaisia. Lisäksi tutkimus osoittaa ihoa säästävän rinnanpoiston ja välittömän rintarekonstruktion olevan myös syövänhoidollisesti turvallinen hoitomuoto, sillä rekonstruktiopotilailla ei esiinny enempää syövän uusiutumia kuin pelkän rinnanpoiston jälkeenkään.
    Full-text · Article · · International Journal of Surgical Oncology
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