title: Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study.
abstract: BACKGROUND
  The management of early breast cancer (BC) with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on level-1 evidence. In this study, the oncological outcome, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis is evaluated.
  
  
  METHODS
  137 SSMs with IBR (10 bilateral) were undertaken in 127 consecutive women, using the LD flap plus implant (n = 85), LD flap alone (n = 1) or implant alone (n = 51), for early BC (n = 130) or prophylaxis (n = 7). Nipple reconstruction was performed in 69 patients, using the trefoil local flap technique (n = 61), nipple sharing (n = 6), skin graft (n = 1) and Monocryl mesh (n = 1). Thirty patients underwent contra-lateral procedures to enhance symmetry, including 19 augmentations and 11 mastopexy/reduction mammoplasties. A linear visual analogue scale was used to assess patient satisfaction with surgical outcome, ranging from 0 (not satisfied) to 10 (most satisfied).
  
  
  RESULTS
  After a median follow-up of 36 months (range = 6-101 months) there were no local recurrences. Overall breast cancer specific survival was 99.2%, 8 patients developed distant disease and 1 died of metastatic BC. There were no cases of partial or total LD flap loss. Morbidities included infection, requiring implant removal in 2 patients and 1 patient developed marginal ischaemia of the skin envelope. Chemotherapy was delayed in 1 patient due to infection. Significant capsule formation, requiring capsulotomy, was observed in 85% of patients who had either post-mastectomy radiotherapy (PMR) or prior radiotherapy (RT) compared with 13% for those who had not received RT. The outcome questionnaire was completed by 82 (64.6%) of 127 patients with a median satisfaction score of 9 (range = 5-10).
  
  
  CONCLUSIONS
  SSM with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically safe for T(is), T1 and T2 tumours without extensive skin involvement.
authors.affiliation: The London Breast Institute, The Princess Grace Hospital, London, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Reefy
authors.forename: Neill
authors.initials: N
authors.lastname: Patani
authors.forename: Anne
authors.initials: A
authors.lastname: Anderson
authors.forename: Gwyne
authors.initials: G
authors.lastname: Burgoyne
authors.forename: Hisham
authors.initials: H
authors.lastname: Osman
authors.forename: Kefah
authors.initials: K
authors.lastname: Mokbel
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D008131:London; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009558:Nipples / Q000601:surgery; D017060:Patient Satisfaction; D018714:Radiotherapy, Adjuvant; D012867:Skin / Q000473:pathology; D016038:Skin Transplantation; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome