Justification for preservation of the projected skin flap above the tumor during surgical treatment of primary resectable breast cancer

Abstract

Aim. Improvement of the aesthetic outcomes of reconstructive plastic surgery for nodular breast cancer due to the scientific rationale of conservation of the projected skin flap and moving the postoperative scar to aesthetically acceptable zones.
 Methods. Data of clinical and instrumental methods of investigation of 240 patients with primary resectable breast cancer were analyzed. The probability of involvement of the front layer of the superficial fascia in the projection of a malignant tumor depending on its clinical and topographic anatomical figures was estimated.
 Results. The study revealed that the fascia involvement does not depend on the skin flattening. The skin flatte­ning is an indirect sign of superficial tumors having a probability of intimate adherence of the tumor to the fascia of 31.8±0.401%. In turn, the intimate adherence of the tumor to the front layer of the superficial fascia with a pro­bability of its involvement of 39.3±0.41% is a significant risk factor for the projected skin flap involvement. It was also found that involvement of the fascia studied does not depend neither on the size of the tumor, nor on the nodal status, nor on the biological subtype. The key risk factor is the depth of the tumor.
 Conclusion. The indication for the projection skin flap preservation is the location of a malignant tumor at a depth of more than 1.05 cm, at which the probability of affecting the fascia is statistically insignificant and is 1.7±0.1%, which requires placing the subcutaneous tissue resection line in the tumor projection from the side of preserved skin flap.