Abstract
BackgroundSkin-sparing mastectomy (SSM) and latissimus dorsi (LD) flap immediate breast reconstruction (IBR) is a tailored surgical procedure. The surgical and patient-reported outcome (PRO) of SSM and LD IBR were assessed.MethodsRetrospective data of 146 SSMs performed by a single surgeon was reviewed. Among patients included in the data, 65 patients underwent SSM and LD IBR without a prosthetic implant. A survey estimating the degree of patient satisfaction (poor, fair, good, and excellent) as regards the cosmetic outcomes of surgery was performed. The patients were divided into two groups according to their degree of satisfaction (excellent group versus non- excellent group), and analysis was done to identify factors affecting the highest patient satisfaction.ResultsThe mean age of the patients was 48.4 years, and pathological results were: infiltrating ductal carcinoma (n = 48, 73.8%), ductal carcinoma in situ (n = 15, 23.1%), and others (n = 2, 3.1%). One patient received postmastectomy radiotherapy. After a mean follow-up of 34 months, no local recurrence occurred. There was no skin necrosis or LD flap loss. Donor site morbidities were seroma (n = 8, 12.3%), scarring (n = 8, 12.3%), and back pain (n = 6, 9.2%). Fifty patients (76.9%) were satisfied and 40% reported their degree of satisfaction as excellent. Breast symmetry (P <0.001), nipple cosmesis (P <0.001), visual difference of bilateral breasts (P = 0.021), and panel assessment score (P <0.001) were factors that affected the highest patient satisfaction.ConclusionsOur SSM and LD IBR was safe, with no local recurrence and low morbidities, and produced a sufficiently high level of patient satisfaction. Achieving breast symmetry and nipple cosmesis would be the key to meeting the patient’s expectation.
Highlights
Skin-sparing mastectomy (SSM) and latissimus dorsi (LD) flap immediate breast reconstruction (IBR) is a tailored surgical procedure
SSM followed by immediate breast reconstruction (IBR) with autologous tissue can be achieved utilizing options such as latissimus dorsi (LD) myocutaneous flap and transverse rectus abdominis myocutaneous (TRAM) flap
Concerns regarding local control and appropriate indications were raised [14], the available data do not support an increase in the risk of local recurrence with SSM when an accurate surgical dissection is performed [3,5,6]; and recently, in a meta-analysis of nine studies comprising 3,739 patients [4], no significant difference in local recurrence was noted between 1,104 patients with SSM and IBR, and 2,635 patients with conventional mastectomies without reconstruction
Summary
Skin-sparing mastectomy (SSM) and latissimus dorsi (LD) flap immediate breast reconstruction (IBR) is a tailored surgical procedure. The surgical and patient-reported outcome (PRO) of SSM and LD IBR were assessed. The fundamental goal in surgical management of breast cancer is to achieve local control and to provide information for planning adjuvant local and systemic therapy. Surgical management of breast cancer has evolved from radical mastectomy to breastconserving surgery. SSM followed by immediate breast reconstruction (IBR) with autologous tissue can be achieved utilizing options such as latissimus dorsi (LD) myocutaneous flap (with or without prosthetic implant) and transverse rectus abdominis myocutaneous (TRAM) flap. Immediate LD flap reconstruction without prosthetic implant is the most common sequence after SSM at our institution, since Korean breast cancer patients generally have small to moderately-sized breasts. The oncological safety of SSM with IBR has been demonstrated in the literature [3,4,5,6,7,8]
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