1
|
Fujii T, Nakazawa Y, Ogino M, Obayashi S, Yajima R, Honda C, Nakamura H, Makiguchi T, Shirabe K. Oncological safety of immediate breast reconstruction with skin- or nipple-sparing mastectomy: the value of tumor-to-dermis distance measured by preoperative ultrasonography. World J Surg Oncol 2021; 19:72. [PMID: 33712034 PMCID: PMC7955614 DOI: 10.1186/s12957-021-02185-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Immediate breast reconstruction with skin-sparing (SSM) or nipple-sparing mastectomy (NSM) has become a common procedure. In this study, we evaluated the distance between breast tumor and skin in a series of patients undergoing IBR as it relates to oncologic safety, namely, the incidence of recurrence. Methods The distance of the tumor to the dermis, rather than the outer layer of skin, was the key parameter of our preoperative ultrasound measurements. Our data set comprised the cases of 171 patients and 181 breasts with breast cancer that had undergone two-stage breast reconstruction by expander. The median age of the patients was 47 years (25–75 years). The overall median follow-up period was 47.1 months (8.8–125.3 months). Eighty-five breasts underwent IBR with SSM/NSM; the others underwent conventional mastectomy. Results Among the total of 181 reconstructed breast mounds, the locoregional recurrence rate was 1.1% (2 breasts) with no cases of skin flap recurrence or skin flap necrosis. The tumor-to-dermis distance of cases with skin preservation (NSM/SSM) was significantly less than that of cases with conventional mastectomy (3.8 ± 2.7 mm vs 5.2 ± 2.4 mm). In cases with invasive carcinoma, all cases whose tumor-to-dermis distance was less than 2 mm underwent resection of the skin immediately overlying the tumor. Conclusions Our results suggested that a 2-mm distance between the dermis and tumor on ultrasound evaluation is sufficient for the use of this tissue as a skin flap in SSM/NSM procedures. Our study indicated that immediate breast reconstruction with SSM/NSM can be an oncologically safe surgical option for breast cancer. However, we recommend that resection of the skin overlying the tumor be performed in cases with invasive breast cancer in which the tumor-to-dermis distance is less than 2 mm. Trial registration Patients in this study were retrospectively registered. This study design was approved by our Clinical Ethics Committee (No 1297) (http://ciru.dept.showa.gunma-u.ac.jp/guidance/storage-sample/list.html).
Collapse
Affiliation(s)
- Takaaki Fujii
- Division of Breast and Endocrine Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, 371-8511, Gunma, Japan. .,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Yuko Nakazawa
- Division of Breast and Endocrine Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, 371-8511, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Misato Ogino
- Division of Breast and Endocrine Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, 371-8511, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Sayaka Obayashi
- Division of Breast and Endocrine Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, 371-8511, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Reina Yajima
- Division of Breast and Endocrine Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, 371-8511, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Chikako Honda
- Division of Breast and Endocrine Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, 371-8511, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideharu Nakamura
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, 371-9511, Gunma, Japan
| | - Takaya Makiguchi
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, 371-9511, Gunma, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| |
Collapse
|
2
|
Prepectoral Implant-Based Breast Reconstruction with Postmastectomy Radiation Therapy. Plast Reconstr Surg 2018; 142:1-12. [PMID: 29878988 DOI: 10.1097/prs.0000000000004453] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Two-stage subpectoral implant-based breast reconstruction is the most common method for breast reconstruction. Recent advances in surgical techniques and technology have made prepectoral implant-based breast reconstruction feasible. There are limited data on outcomes after prepectoral implant-based breast reconstruction and postmastectomy radiation therapy. METHODS A retrospective review of consecutive patients undergoing immediate two-stage prepectoral implant-based breast reconstruction with postmastectomy radiation therapy was performed. Outcomes of irradiated breasts were compared with nonirradiated breasts in bilateral cases. RESULTS Ninety-three cases of prepectoral implant-based breast reconstruction in 54 women who underwent immediate two-stage reconstruction (39 bilateral and 15 unilateral) and unilateral postmastectomy radiation therapy were identified. Mean follow-up was 19 months from mastectomy and tissue expander reconstruction and 9 months from implant placement. Crude complication rates in irradiated versus nonirradiated sides were as follows: surgical-site infection, 18.5 percent versus 7.7 percent; seroma, 5.6 percent versus 5.1 percent; mastectomy skin flap necrosis, 1.9 percent versus 2.6 percent; wound dehiscence, 1.9 percent versus 7.7 percent; capsular contracture, 1.9 percent versus 0 percent; hematoma, 1.9 percent versus 2.6 percent; and extrusion, 1.9 percent versus 0 percent. On univariate analysis, there were no risk factors associated with any complication, including radiation therapy, surgical-site infection, unplanned readmissions, and unplanned return to the operating room. To date, reconstruction has been completed in 96 percent of patients, with successful implant-based breast reconstruction in 81 breasts (45 irradiated breasts and 36 nonirradiated breasts). CONCLUSIONS Early data of prepectoral implant-based breast reconstruction in patients with postmastectomy radiation therapy show promising results. Postmastectomy radiation therapy should not be an absolute contraindication to prepectoral implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|