Subcutaneous Mastectomy with Immediate Reconstruction as Treatment for Early Breast Carcinomas

Kang, Su Hwan; Lee, Soo Jung; Woo, Sang Hyun; Jeong, Jae Ho; Seul, Jung Hyun

Abstract

BACKGROUND: Breast-conservation surgery is now widely used, but is inappropriate in some patients with high risk of recurrence and in patients who refuse radiation therapy. A number of women who undergo a mastectomy in these circumstances request reconstruction. Recently, subcutaneous mastectomies have been performed through an inframammary incision or incision down the lateral side of the breast. The purpose of the present study was to determine the cosmetic results and the complications after a subcutaneous mastectomy using a newly designed skin incision and immediate reconstruction.
METHODS
Subcutaneous mastectomies with immediate reconstruction were performed in 17 patients with early breast cancer from June 1997 to November 1998. The inclusion criteria for this procedure were a peripherally located tumor, a size smaller than the T2 size, clinically negative axillary lymph nodes, and a grossly normal nipple and areolar area. A radial skin incision from the lateral edge of the areolar or an incision down the lateral side of the breast with or without an axillary incision was performed, depending on the location of the tumor. If two or more metastatic nodes among 5 or 6 nodes were confirmed by frozen biopsy, we planned a delayed reconstruction. To avoid nipple-areolar recurrence, we performed a frozen biopsy of the resection margin.
RESULTS
The mean age of the patients was 38, and the majority of tumors were invasive ductal tumors (9 cases) and DCIS tumors (5 cases). All of the tumor sizes were less than 3 cm (T1: 10 cases, T2: 7 cases). All of the tumors were stage 0 to stage 2 at the time of operation. Thirteen permanent saline-filled protheses, two tissue expanders, one conventional flap, and one free TRAM flap were used for reconstruction. Immediate postoperative complications were 4 case of transient ischemic necrosis of the nipple- areolar area, one case of complete necrosis of the nipple-areolar area, and three case of transient focal skin necrosis. Three of these patients had both transient ischemic necrosis of the skin and the nipple- areolar area. Loss of touch sensation in the central portion of breast occurred in all cases. The majorcosmetic problems were 4 cases of asymmetric breasts and 2 cases of nipple displacement, which was more common in patients with a ptotic breast and in patients who had received a skin incision through the lateral edge of the breast. Excellent or good cosmetic results were obtained in 75% of the patients. There was no local recurrence, but the follow up was short term (mean follow-up period: 12 months). A radial skin incision, with or without axillary incision, was more cosmetic and more easily and completely dissected the breast parenchymal tissue than a lateral incision of the breast was.
CONCLUSION
These results support the use of this technique in the treatment of early breast cancer.