E-poster Presentation 2014 World Cancer Congress

Skin-sparing Mastectomy with Immediate Breast Reconstruction - When feasible, why not! (#897)

Shravan Nadkarni 1 , Atul Ameta 1 , Ranjan Kumar 1 , Ashish Goyal 1 , Sumita Jain 1 , Lakshman Agarwal 1

Background:Conventional breast cancer surgery is mutilating & impedes reconstructive procedures. Skin-sparing mastectomy (SSM) removes the breast tissue, nipple–areola complex (NAC), and previous biopsy incisions. It preserves the inframammary fold and native skin over the breast and is increasingly being employed in the treatment of breast cancer to improve the aesthetic results of immediate breast reconstruction.

Aim:1. To evaluate the utility of Skin sparing Mastectomy with breast reconstruction in the same sitting as a procedure of choice in eligible patients of breast cancer

 2. To study the tumour characteristics, post-operative complications, aesthetic results and patient satisfaction using the BREAST-Q questionnaire.

Methods:Patients with operable breast cancer, satisfying the inclusion and exclusion criteria were selected after proper evaluation. They underwent skin sparing mastectomy and immediate breast reconstruction.Their tumour characteristics (age, menopausal status, tumour size, grade, margin status and lymph nodal positivity) post-operative complications, aesthetic results and patient satisfaction were reviewed

Results:25 patients underwent SSM with IBR using Latissimus Dorsi pedicled flap. All patients were small to medium cup-size. 18 patients had multicentric tumour & the rest had unicentric tumour in whom breast conservation could not be offered. Resected margins were negative & lymph node clearance was adequate. 1 patient had local wound infection, 1 had local hematoma & 2 patients had skin envelope necrosis. Post operatively patient’s aesthetic results and satisfaction were evaluated using Breast-Q questionnaire. 72% patients had scores denoting SATISFIED, 12% patients scored VERY SATISFIED.

Conclusions:SSM with IBR has become increasingly popular as an effective treatment for patients with breast cancer where breast conservation is not possible. With SSM the endangered breast tissue could be removed with safe margins while the spared skin could still function cosmetically. This provides opportunity for enhanced aesthetic outcomes with immediate reconstruction without compromise of local oncological safety. Patient satisfaction remains high with low psychological trauma.

  1. Carlson GW, Bostwick J 3rd, Styblo TM, Moore B, Bried JT, Murray DR. et al. Skin sparing mastectomy, oncologic and reconstructive considerations. Ann Surg. 1997;225:570-5
  2. Simmons RM, Adamovich TL. Skin-sparing mastectomy. Surg Clin North Am. 2003;83:885-99
  3. Lim W, et al. Oncological safety of skin sparing mastectomy followed by immediate reconstruction for locally advanced breast cancer. Journal of Surgical Oncology 2010;102(1):39–42
  4. Malata CM, McIntosh SA, Purushotham AD. Immediate breast reconstruction after mastectomy for cancer. Br J Surg. 2000;87:1455-72
  5. Foster RD, Esserman LJ, Anthony JP, Hwang ES, Do H. Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advancd stages of breast carcinoma. Ann Surg Oncol. 2002;9:462-6