Ultra-conservative skin-sparing 'keyhole' mastectomy and immediate breast and areola reconstruction.
The popularity of skin-sparing mastectomy (SSM) which preserves the breast skin envelope is increasing, but the risks and benefits of this approach are only beginning to emerge. A technique involving ultra-conservative SSM and immediate breast reconstruction (IBR) has been evaluated to establish the surgical and oncological sequelae of skin conservation. Between 1994-1998, 67 consecutive patients underwent 71 SSM and expander-assisted immediate latissimus dorsi (LD) breast reconstructions (follow up, 24.1 months; range, 2-52 months). Breast resection, axillary dissection and reconstruction were performed through a 5-6 cm circular peri-areolar 'keyhole' incision. Patients were discharged 6.5 days (range, 5-15 days) after the 3.9 h (range, 3.0-5.5 h) procedure, and expansion was completed by 4.0 months (range, 0-10 months). Local recurrence occurred in 3% of breasts at risk, skin envelope necrosis occurred in 10%, and contralateral surgery was required to achieve symmetry in 14%. SSM and IBR is an oncologically safe, minimal-scar procedure which can be performed by surgeons trained in 'oncoplastic' techniques. It results in low rates of local recurrence and complication, and reduces the need for contralateral surgery.
Peyser
P M
PM
Breast Unit, Royal Hampshire County Hospital, Winchester, UK.
Abel
J A
JA
Straker
V F
VF
Hall
V L
VL
Rainsbury
R M
RM
D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009336:Necrosis; D011183:Postoperative Complications; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D013524:Surgical Flaps; D015626:Tissue Expansion / Q000379:methods