title: Skin-sparing mastectomy and immediate latissimus dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes.
abstract: BACKGROUND
  Skin-sparing mastectomy (SSM) and latissimus dorsi (LD) flap immediate breast reconstruction (IBR) is a tailored surgical procedure. The surgical and patient-reported outcome (PRO) of SSM and LD IBR were assessed.
  
  
  METHODS
  Retrospective data of 146 SSMs performed by a single surgeon was reviewed. Among patients included in the data, 65 patients underwent SSM and LD IBR without a prosthetic implant. A survey estimating the degree of patient satisfaction (poor, fair, good, and excellent) as regards the cosmetic outcomes of surgery was performed. The patients were divided into two groups according to their degree of satisfaction (excellent group versus non- excellent group), and analysis was done to identify factors affecting the highest patient satisfaction.
  
  
  RESULTS
  The mean age of the patients was 48.4 years, and pathological results were: infiltrating ductal carcinoma (n = 48, 73.8%), ductal carcinoma in situ (n = 15, 23.1%), and others (n = 2, 3.1%). One patient received postmastectomy radiotherapy. After a mean follow-up of 34 months, no local recurrence occurred. There was no skin necrosis or LD flap loss. Donor site morbidities were seroma (n = 8, 12.3%), scarring (n = 8, 12.3%), and back pain (n = 6, 9.2%). Fifty patients (76.9%) were satisfied and 40% reported their degree of satisfaction as excellent. Breast symmetry (P <0.001), nipple cosmesis (P <0.001), visual difference of bilateral breasts (P = 0.021), and panel assessment score (P <0.001) were factors that affected the highest patient satisfaction.
  
  
  CONCLUSIONS
  Our SSM and LD IBR was safe, with no local recurrence and low morbidities, and produced a sufficiently high level of patient satisfaction. Achieving breast symmetry and nipple cosmesis would be the key to meeting the patient's expectation.
authors.affiliation: Department of Surgery, Soonchunhyang University Hospital, Hannam-dong, Yongsan-gu, Seoul 140-743, Korea.
authors.forename: Zisun
authors.initials: Z
authors.lastname: Kim
authors.forename: Sang Gue
authors.initials: SG
authors.lastname: Kang
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Roh
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Park
authors.forename: Jihyoun
authors.initials: J
authors.lastname: Lee
authors.forename: SungYong
authors.initials: S
authors.lastname: Kim
authors.forename: Cheol Wan
authors.initials: CW
authors.lastname: Lim
authors.forename: Min Hyuk
authors.initials: MH
authors.lastname: Lee
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013524:Surgical Flaps