Skin-sparing mastectomy with immediate latissimus dorsi flap reconstruction versus delayed reconstruction after modified radical mastectomy

Ahmed F. El-kased; Mohammed H. El-Meligy; Mahmoud A. Abd El-Shafie

doi:10.18203/2349-2902.isj20194161

Authors

Ahmed F. El-kased Department of General Surgery, Menofia Faculty of Medicine, Shebin El-Kom, Egypt
Mohammed H. El-Meligy Department of General Surgery, Menofia Faculty of Medicine, Shebin El-Kom, Egypt
Mahmoud A. Abd El-Shafie Department of General Surgery, El-Mahalla General Hospital, Gharbia, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20194161

Keywords:

Skin sparing mastectomy, LD flap, Immediate breast reconstruction, Delayed reconstruction, Modified radical mastectomy

Abstract

Background: Oncoplastic breast surgery is a safe option in the treatment of early-stage breast cancer that preserves cosmoses without compromising recurrence or survival. Skin sparing mastectomy is oncologically safe based on the absence of breast ductal epithelium at the margin of the native skin flaps. Breast reconstruction with latissimus dorsi (LD) flap produces a high rate of good aesthetic results.

Methods: This clinical study included 20 patients who were managed in the general surgery department, Menofiua university hospitals from April 2017 to March 2019. All patients had early breast cancer.

Results: Patients with SSM were younger than those with LD flap. In cases of SSM LD flap, average of operative time was 4.95 hours, range 4-6.5 hours, and a median of 4.75 hours with SD ±0.89. While in cases who did delayed LD flap Average time 2.8 hours and range 1.5-3.5 hours and SD ±0.65. The difference was significant. Average blood loss for the patients underwent SSM with LD flap was 975 cc while in those who underwent delayed LD flap reconstruction was 520 cc, and the difference was significant.

Conclusions: Skin-sparing mastectomy with immediate LD has become popular; it improves the cosmetic result, reduces cost, and anesthetic risk. It doesn't interfere with radiotherapy or chemotherapy.

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References

Lucy D, Stephanie A, Abhishek C, Rula G, Nadia N, Brian J, Julia T, Carla S. Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients. A Systematic Literature Review. Annals Oncoplastic Surg. 2016;23(10):3247-58.

Damian M, Virgilio S. Skin sparing mastectomy. Oncoplastic Reconstructive Breast Surg. 2019;2(6):257-63.

Pawel S, Kenneth S, Marek Z, Mark B, Cameron R. Autologous Breast Reconstruction with the De-nervated. Extended Latissimus Dorsi Musculocutaneous Flap. Springer Int Publishing Switzerland. 2016;6:717-25.

Mahshid G, Zahra P, Hamid S. Incidence and Mortality and Epidemiology of Breast Cancer in the World. Asian Pac J Cancer Prev. Cancer Control in Western Asia Special Issue. 2016;2:3:43-6.

Choi JY, Alderman AK, Newman LA. Aesthetic and reconstructive considerations in oncologic breast surgery. J Am Coll Surg. 2006;2(2):943–4.

Fisher B, Anderson S, Bryant J. Twenty-year follow-up of a randomized trial comparing total mastectomy. Lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;4(6):1233-41.

Mohamed S, Wail S, Antony J, Susan S, Joan T, Kefah M. Skin-sparing mastectomy and immediate breast reconstruction. Patient satisfaction and clinical outcome. Int J Clin Oncol. 2006;11(1):51-4.

Galen P, Stephanie K, George C, Dustin E. Latissimus Dorsi Myocutaneous Flap for Breast Reconstruction: Bad Rap or Good Flap?. Eplasty. 2011;3(7):411-6.

Meretoja T, Rasia S, von Smitten K, Asko-Seljavaara S, Kuokkane H, Jahkola T. Late results of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg. 2007;94(10):1220–5.

Munhoz AM, Aldrighi C, Montag E, Arruda EG, Aldrighi JM, Filassi JR, et al. Periareolar Skin-Sparing Mastectomy and Latissimus Dorsi Flap with Bio dimensional Expander Implant Reconstruction. Surgical Planning, Outcome, and Complications. Plastic Reconstructive Surg. 2007;119(6):1637-49.

Hammond DC. Latissimus drsi flap breast reconstruction. Plastic and reconstructive surgery. 2009;124(4):1055-63.

Mohammed A, Ayman A, Mahmoud B, Ayman N, Sherif M. The extended latissimus dorsi flap option in autologous breast reconstruction. A report of 14 cases and review of the literature. Indian J Plastic Surg. 2008;41(1):24-33.

Roostaeian J, Sanchez I, Vardanian A, Herrera F. Comparison of immediate placement versus the staged tissue expander technique in breast reconstruction. Plast Reconstr Surg. 2012;129(6):909-18.

Giles H, Kefah M: Skin sparing mastectomy. The Am J Surg, 2004;4(12):78-84.

Xavier H, Kouwenberg CAE, Bijlard E, Burger KNJ, Jager A, Mureau MAM. The effect of immediate breast reconstruction on the timing of adjuvant chemotherapy. a systematic review. Breast Cancer Res Treat. 2015;153(2):241–51.

Steele K, Macmillan R, Ball G, Akerlun M, McCulley S. Multicentre study of patient-reported and clinical outcomes following immediate and delayed Autologous Breast Reconstruction and Radiotherapy (ABRAR study). J Plastic Reconstructive Aesthetic Surg. 2018;71(2):185–93.