Evolving role of skin sparing mastectomy

Skin sparing mastectomy(SSM) can facilitate immediate breast reconstruction and is associated with an excellent aesthetic result. The procedure is safe in selected cases; including invasive tumours < 5 cm, multi-centric tumours, ductal carcinoma in situ and for risk-reduction surgery. Inflammatory breast cancers and tumours with extensive involvement of the skin represent contraindications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy do not preclude SSM, however the aesthetic outcome may be compromised. Preservation of the nipple areola complex is safe for peripherally located node negative tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be considered in these cases. The advent of acellular tissue matrix systems has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetic outcome.

Skin Sparing Mastectomy in Locally Advanced Breast Cancer: A Possibility?

Breast cancer is the second most common cause of cancer death in women in India in spite of advances in the adjuvant treatment of breast cancer. Locally advanced breast cancer (LABC) still represents the major presenting picture in many urban and rural institutions in our country. Skin Sparing Mastectomy (SSM) and primary reconstruction is a popular option for patients with breast cancer. There are similar local and distant recurrences in SSM compared to the traditional non-skin sparing mastectomy. A 57-year-old lady presented with a locally advanced left breast cancer. After undergoing neoadjuvant chemotherapy and a PET-CT to accurately detect residual disease in breast and axilla, she underwent skin sparing mastectomy with nipple-areola complex preservation and primary reconstruction with silicon prosthesis implant over a latissimus dorsi myocutaneous flap for primary reconstruction. SSM in LABC has not been reported in the literature so far. This patient is disease free for the past 24 months.

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nipple-areola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New tech-niques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Nipple-sparing mastectomy(NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon andcareful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon's experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.

Nipple-Areola Sparing Mastectomy Followed by Immediate Breast Reconstruction in 126 Patients

This study is to explore the indications, procedures, effectiveness, and feasibility of nipple-areola sparing mastectomy followed by immediate breast reconstruction. The nipple-areola sparing mastectomy followed by immediate breast reconstruction was performed in 126 patients with breast cancer from June 2005 to October 2011. The cosmetic outcomes of the reconstructed breasts were evaluated according to objective and subjective criteria. Meanwhile, the postoperative complications were observed and the therapeutic efficacies were followed up. All the operations were successful. Six patients experienced mild complications early after surgery and were resolved after symptomatic treatment. Both the subjective and objective evaluation for the aesthetic outcomes yielded a satisfactory rate of 97.62% during the 6-80-month follow-up. No recurrence or metastasis was found in 118 cases. Nipple-areola sparing mastectomy followed by immediate breast reconstruction is a simple and effective option for significantly improving the cosmetic outcomes and quality of life of patients, without serious complications or impact on the comprehensive treatment and long-term effect against breast cancer.

Aesthetic Outcome after Nipple Sparing Mastectomy for Cancer Patient Egyptian Pattern

Background: Recent advances in breast reconstruction and the introduction of oncoplastic techniques have resulted in significant improvement in quality of life and psychological well-being of most patients. Nipple sparing mastectomy is a surgical technique that removes breast tissue while preserving the native skin envelope, infra-mammary fold and the NAC, which allows immediately reconstructed breasts to have an excellent cosmetic outcome. Aim: Our primary end point was for objective assessment of aesthetic outcome after NSM via more accurate new method and subsiding bias in that assessment and the secondary end point was for evaluating the influence of incision choice and recommending which incision is the best for each patient putting in mind cup size, degree of ptosis and body mass index of Egyptian patients. Methods: Starting January 2013 to November 2015, 74 patients with breast cancer underwent NSM with immediate reconstruction using LD flap with or without implant augmentation. Results: Incisions used are elliptical (37.8%), lateral (27%), peri-areolar (21.6%) and infra-mammary (13.5%). In 81.1% of the patients, the procedure was performed using extended LD flaps only, while in the remaining 18.9% the flaps were augmented using implant insertion. Axillary dissection was done in 68.9% of patients and SLN in 24.3% of patients. Overall aesthetic results were done by patient self-assessment, assessment by the surgeon, assessment by professional plastic breast surgeon and assessment by onco-plastic surgeon, and this was followed by statistical analysis of the agreement between the plastic surgeon and the onco-plastic surgeon. Conclusion: NSM is safe, feasible and offers adequate oncologic results along with excellent cosmetic outcome. Choice of incision and reconstruction should be tailored to suit each patient. Breast cancer patients can benefit from sound resection and enjoy a sense of wholeness.

Usefulness of Free Nipple-Areola Complex Graft for Nipple Malposition after Nipple Sparing Mastectomy

Purpose: This article identifies the advantage and disadvantage of a free nipple areola complex graft (FNACG) for nipple malposition which resulted from tissue-expander insertion and subsequently replaced with an implant after nipple sparing mastectomy (NSM). Methods: The subjects were three such patients treated using FNACG and who were followed up for at least one year postoperatively. The surgical outcome was assessed for symmetry of nipple-areola position, graft take, depigmentation, and shrinkage. Results: In all patients, the graft was accurately transferred to a position to achieve symmetry with the unaffected breast, and there was complete graft take in the areola by simple surgical design and techniques. No depigmentation of the areola was observed. The size of the areola was almost unchanged after grafting in two patients, but areolar shrinkage occurred in one other patient. There was complete graft take in the nipple in one patient and no depigmentation of the nipple was observed. Necrosis occurred at the tip of the nipple in two other patients. These patients had depigmentation, and the height of nipples decreased in proportion to the level of necrosis. Conclusion: FNACG can be a useful method if its advantages and disadvantages are well considered.

The Place of Nipple-Sparing Mastectomy in the Treatment of Breast Cancer: Review of the Literature

Introduction: Mastectomy with conservation of the nipple-areola complex (NAC) in breast cancer care has been controversial with regards to the oncological safety of this procedure and the risk of complications including NAC necrosis. Aim: The objective of this study is to assess, through a literature review, the safety and reliability of a conservative NAC mastectomy in breast cancer treatment, paying attention to the rate of local recurrence and complications. Methods: A review of the literature was conducted from PubMed data, and articles published between January 2007 and December 2017, using the terms “nipple-sparing mastectomy”, “breast cancer”, “local recurrence”, “necrosis of the nipple”, “global complications”. The articles were analyzed with regards to the following parameters of evaluation: local recurrence, recurrence rate at NAC level, global complication rates and nipple necrosis rates. Results: In the 36 studies we selected, the average rate of local recurrence was 3.23%. The average rate of recurrence at the NAC was 0.81%. The average rate of complications was 20%. The average rate of necrosis of the NAC was 5.9%. The main factors of these recurrences were the tumor size > 5 cm and tumor stage > stage II. Conclusion: Conservative mastectomy of the nipple-areola complex offers an aesthetic advantage and oncological safety in carefully selected patients with breast cancer.

Mastectomy—A Critical Review

History of breast cancer dates back to at least 1600 B.C. and treatment methods have undergone significant progress over the last hundred years. We are moving away from frighteningly radical, and towards increasingly more conservational breast cancer surgery. And while mastectomy is no longer a first-line choice for all breast cancers, it is still an important and, really, an essential procedure to discuss and research about. Different types and techniques exist and evidence regarding each is vast-with novel techniques appearing even nowadays. For example, robotic surgery is increasingly more common in many surgical specialties and procedures, and mastectomy is no exception. With several high-profile celebrities recently discussing their experiences of breast cancer and mastectomies, this article covers a multitude of essential aspects relevant to this topic, in turn, hopefully, helping patients and doctors deal with the diagnosis and plan the treatment accordingly. Current breast cancer care and mastectomy trends are also discussed here, giving the readers an up-to-date overview of how breast cancer can and should be managed.

Effect of neoadjuvant chemotherapy on skin-sparing mastectomy and breast reconstruction modalities in 409 patients

Aim:While skin-sparing mastectomy(SSM)can be performed in patients with stage II-III breast cancer,the impact of neoadjuvant chemotherapy(NAC)on SSM rates and reconstructive modalities in these patients is not known.Methods:Between January 2007 and December 2009,409 immediate breast reconstructions(IBRs)were performed in patients with Stage II-III breast cancer.Data were collected on preoperative,operative,and postoperative factors.Results:There was a statistically significant relationship between clinical stage of disease and the utilization of SSM or non-SSM(P<0.0001).Seventy-five percent of all patients with stage II disease and 50%of patients with stage III disease underwent SSM;similarly,75.5%of patients with stage II and 49.1%of patients with stage III disease who received NAC underwent SSM with immediate reconstruction,in spite of having a greater proportion of stage III patients(P<0.01).In addition,patients who received NAC followed by SSM with IBR had larger tumors(mean,3.5 cm vs.3.1 cm,P<0.001).The type of IBR,and size of skin defect was significantly affected by whether the patient underwent SSM or non-SSM(P=0.001,P<0.01,respectively).Conclusion:We are increasingly considering NAC to be an important tool to potentially reduce the morbidity of mastectomy,including the need to resect breast skin,which can subsequently enhance reconstructive outcomes in patients with clinical stage II and III breast cancer.Specifically,our data suggest that NAC patients with stage II and III breast cancer and larger tumors can reliably and safely undergo SSM in nearly half of cases,thus improving reconstructive outcomes and patient well-being.

Expanding the Use of Nipple-Sparing Mastectomies in Obese Patients Undergoing Staged Implant-Based Reconstruction

Background: Advantages of various mastectomy techniques include skin reduction and favorable aesthetics in Wise-pattern closures, and less visible scars in nipple-sparing mastectomies (NSM). This study compares postoperative complication profiles between Wise-pattern and nipple-sparing mastectomies in the obese population. Methods: A retrospective chart review of obese patients (BMI ≥ 30) who underwent staged breast reconstruction following Wise-pattern and nipple-sparing mastectomies at our institution between February 2016 and January 2020 was conducted. Complications between cohorts were analyzed using the independent samples t-test (2-sided) and the χ2 test. Results: A total of 232 breasts (163 Wise-pattern, 69 NSM) were re-constructed in 123 obese female patients (85 Wise-pattern, 38 NSM). Complication rates in both the Wise-pattern and NSM patient cohorts were similar following stage 1 (Wise-pattern: 30.7%, NSM: 39.1%, p = 0.212) and stage 2 (Wise-pattern: 16.6%, NSM: 15.9%, p = 0.907) of reconstruction. No statistically significant differences in rates of infection, dehiscence, seroma, hematoma or malposition of tissue expander (TE)/implant following stage 1 or stage 2 were found between cohorts. Conclusions: There were no significant differences in postoperative complication rates between the Wise-pattern and NSM cohorts of obese patients. NSM can be a viable surgical option in carefully selected obese patients and offer the advantage of concealed scarring.

Nipple-sparing Mastectomy in Breast Cancer： From an Oncologic Safety Perspective

Objective：To evaluate the oncologic safety of nipple-sparing mastectomy （NSM） for breast cancer patients based on current literature.Data Sources：A comprehensive literature search ofMedline,Embase databases was conducted for studies published through March 2014.Study Selection：Our search criteria included English-language studies that focused on NSM at nipple-areola complex （NAC） involvement,patient selection,and recurrence.Prophylaxis NSM,case series or reports that based on very small population were excluded.In the end,42 studies concerning NSM and oncological safety were included into the review.Results：NSM is a surgical procedure that allows the preservation of the skin and NAC in breast cancer patients or in patients with prophylactic mastectomy.However,the oncologic safety and patient selection criteria associated with NSM are still under debate.The incidence of NAC involvement of breast cancer in recent studies ranges from 9.5% to 24.6%,which can be decreased through careful patient selection.Tumour-nipple distance,tumour size,lymph node involvement and molecular characteristics can be evaluated preoperatively by clinical examinations,imaging studies and biopsies to predict the risk of NAC involvement.Currently,there is no available standard protocol for surgical approaches to NSM or pathological examination of NSM specimens.The local recurrence （ranges from 0% to 24%） of NSM is not significantly higher than that of traditional mastectomy in selected patients based on long-term follow-up.The role of radiotherapy in NSM is still controversial and is not universally accepted.Conclusions：NSM appears to be oncologically safe following careful patient selection and assessment of margins.

U型多点缝合固定皮瓣及三管负压引流预防乳腺癌改良根治术术后积液的疗效研究

目的 探讨U型多点缝合固定皮瓣及三管负压引流预防乳腺癌改良根治术Ⅰ式术后积液的效果。方法 选取158例行乳腺癌改良根治术Ⅰ式患者为研究对象,根据不同的皮瓣缝合方式将患者分为观察组(n=78)和对照组(n=80),观察组采取U型多点缝合固定皮瓣及三管负压引流,对照组采取常规缝合及引流方式,术后比较两组患者手术相关并发症的发生率、术后引流量、皮瓣及腋窝置管时间和住院时间。结果 观察组术后出现皮下积液8例(10.26%),低于对照组的23例(28.75%),观察组发生皮瓣坏死1例(1.28%),低于对照组的8例(10.00%),组间比较差异均有统计学意义(P均<0.05)。观察组术后1~5天引流量均显著低于对照组(P均<0.001)。观察组术后皮瓣置管时间、腋窝置管时间及患者住院时间较对照组均明显缩短(P均<0.001)。结论 U型多点缝合固定皮瓣及三管负压引流较常规缝合引流能有效减少术后积液量,降低皮下积液及皮瓣坏死的发生率,缩短患者引流管置管时间及住院时间。

乳腺区段切除术联合随意皮瓣转移术治疗非哺乳期乳腺炎的临床及美学效果

目的:探讨乳腺区段切除术联合随意皮瓣转移术治疗非哺乳期乳腺炎(Non-puerperal mastitis,NPM)的临床及美学效果。方法:选取2019年6月-2021年6月笔者医院收治的88例NPM患者,随机分为对照组和联合组,各44例,对照组给予乳腺区段切除术治疗,联合组给予乳腺区段切除术联合随意皮瓣转移术治疗。比较两组患者术后炎症因子水平、乳房美学效果优良率、并发症及随访1年的治愈和复发情况。结果:术后1周,两组炎症因子水平均低于术前(P<0.05),但组间比较差异无统计学意义(P>0.05);术后1个月,联合组乳房美学效果优良率为90.91%,高于对照组的61.36%(P<0.05);术后1个月内,联合组并发症总发生率为6.82%,低于对照组的22.73%(P<0.05);随访1年,联合组治愈率高于对照组,复发率低于对照组(P<0.05)。结论:乳腺区段切除术联合随意皮瓣转移术治疗NPM,可以缓解炎症反应,提高美学效果,且治愈率高,并发症和复发风险低。

单孔腔镜保留乳头乳晕全乳切除术在早期乳腺癌中的应用效果探讨

目的探讨单孔腔镜保留乳头乳晕全乳切除术在早期乳腺癌中的应用效果。方法选取2021年7月至2022年8月于广西壮族自治区人民医院行保留乳头乳晕全乳切除术的40例患者,其中行单孔腔镜下保留乳头乳晕全乳切除术者20例(腔镜组),开放保留乳头乳晕全乳切除术者20例(开放组)。比较两组手术时间、术中出血量、切口长度、术后住院时间、术后引流量、并发症发生率,以及术后6个月的乳腺癌生存质量测评量表(FACT-B)评分和美容效果满意度评分等。结果两组患者均顺利完成手术并康复出院。腔镜组切口长度短于开放组,但手术时间长于开放组,术后引流量多于开放组,差异有统计学意义(P<0.05)。腔镜组术后6个月FACT-B测评量表评分和美容效果满意度评分高于开放组,差异有统计学意义(P<0.05)。两组术中出血量、术后住院时间、术后并发症发生率比较差异无统计学意义(P>0.05)。结论单孔腔镜下保留乳头乳晕全乳切除术安全有效,具有更好的美容效果和患者满意度,可提高患者的生活质量和心理健康。

保留乳头乳晕复合体乳房切除术联合假体乳房重建的研究进展

乳房重建是全乳切除术后重要的美容修复手段。保留乳头乳晕复合体乳房切除术(NSM)避免了全乳切除术后乳房重建时乳头缺失、乳头重建效果差、手术操作复杂等问题,患者满意度更高。假体乳房重建不涉及供区损伤,对机体创伤小,并发症发生率和再次手术率低,是目前临床使用最广泛的重建方法之一。NSM联合假体乳房重建安全、美观、术后满意度高,可显著改善患者的社会心理健康和生活质量。本文就NSM、假体乳房重建及辅助治疗对NSM联合假体乳房重建的影响进行综述。

经胸外侧单孔非吸脂腔镜技术在早期乳腺癌即刻乳房假体重建中的应用

目的探讨经胸外侧单孔非吸脂腔镜技术在保留乳头乳晕复合体乳房切除(nipple sparing mastectomy,NSM)并即刻假体联合补片乳房重建术的应用效果。方法回顾性分析2020年2月至2022年7月在我科采用经胸外侧单孔非吸脂腔镜技术行NSM并即刻假体联合补片乳房重建术的42例早期乳腺癌女性患者的临床资料,分析围手术期指标、术后并发症、重建乳房美学效果和近期肿瘤安全性。结果42例患者均顺利完成腔镜NSM并即刻乳房重建术,其中该术式开展第1年完成手术12例,1年后完成30例,手术成功率100%。第1年手术组与1年后手术组患者手术时间、术中出血量、术后引流量比较差异均有统计学意义(P<0.001),但拔管时间、术后并发症率比较无统计学差异(P>0.05)。术后乳头乳晕复合体不同程度缺血5例(11.90%),切口愈合不良2例(4.76%),感染1例(2.38%),血清肿6例(14.29%),包膜挛缩5例(11.90%),假体丢失1例(2.38%)。42例患者重建乳房优良率为54.76%(23/42),其中第1年与1年后重建乳房者优良率比较无统计学差异(41.67%vs.60.0%,P>0.05)。42例患者均获随访,随访时间1~30个月,平均18.8个月,无一例肿瘤局部复发或远处转移。结论经胸外侧单孔非吸脂腔镜技术用于早期乳腺癌乳房重建,手术成功率高,术后并发症少,重建乳房美学效果好,近期肿瘤学安全性高;通过练习可以有效缩短腔镜手术时间和学习曲线,提高手术效率。

应用不同重建手术保留乳腺癌患者乳头乳晕的疗效比较及预后分析

目的研究乳腺癌患者应用保留乳头乳晕的乳腺癌根治术后采用不同重建术的临床疗效及影响因素。方法回顾性分析2010年3月至2022年3月上海交通大学乳腺癌数据库中进行保留乳头乳晕的乳房重建手术的患者1408例,根据重建手术方法将其分为一步法组(n=876)和二步法组(n=532),比较两组患者乳房外观美容效果、满意度、并发症、术后复发率及生存质量;再根据患者复发情况将其分为复发组(n=162)和非复发组(n=1246),多因素logistic回归分析患者术后复发的危险因素。结果一步法组患者乳房外观优良率和术后满意度明显高于二步法组(P<0.05);两组患者的并发症发生率、局部复发率差异无统计学意义(P>0.05);术后六个月后两组患者的各项生命质量测定量表(FACT-B)评分均高于术前,并且一步法组患者的FACT-B评分均高于二步法组(P<0.05);复发组患者中年龄>35岁、浸润性非特殊型癌、未行内分泌治疗、未行放疗辅助治疗的比例明显高于非复发组(P<0.05);多因素logistic回归分析显示,年龄>35岁、浸润性非特殊型癌、未行放疗辅助治疗是影响患者术后复发的独立危险因素(P<0.05)。结论一步法重建术对乳腺癌根治术患者具有较高应用价值,值得临床广泛推广;年龄>35岁、浸润性非特殊型癌、未行放疗辅助治疗是影响保留乳头乳晕的乳腺癌根治术患者复发的独立危险因素。

保留乳头乳晕复合体乳房切除术的安全性研究进展

保留乳头乳晕复合体(NAC)乳房切除术(NSM)能提高术后患者的美容效果,减轻乳房缺失带来的心理创伤,但该术式并非适合所有的乳腺癌NSM患者。目前,对于该术式的禁忌证认识相对一致,而对于部分适应证仍存在争议。本文就保留NAC NSM的安全性研究进展进行综述。

湿润烧伤膏治疗乳腺癌根治术后皮瓣坏死疗效分析

目的探讨湿润烧伤膏治疗乳腺癌根治术后皮瓣坏死的临床疗效。方法给予2020年8月至2022年8月北京市昌平区中西医结合医院收治的20例乳腺癌根治术后皮瓣坏死患者局部创面于蚕食清创术后采用湿润烧伤膏换药治疗,观察皮瓣血运恢复及创面愈合情况。结果治疗1周后,所有患者坏死皮瓣血运均完全恢复;治疗3周后,所有患者创面均完全愈合。结论湿润烧伤膏可明显促进乳腺癌根治术后坏死皮瓣血运恢复,加速创面愈合,值得临床推广应用。