Skin Sparing Mastectomy with Immediate Reconstruction

Purpose: Skin-sparing mastectomy with immediate reconstruction is a recent major advance in breast reconstruction after radical glandular mastectomy. This study intended to asses its preliminary results in our patients with regards to oncologic safety and aesthetic quality. Patients and methods: Twenty-eight patients with, early-stage invasive breast cancer, diffuse ductal in-situ carcinoma and large phylloids tumors were operated upon by the periareolar incision approach, followed by immediate reconstruction using pedicled TRAM in 17 patients and latissimus dorsi myocutaneous flap for the other 11.Meticulous pathologic examinations for the mastectomy margins and separate native skin biopsies were done. Aesthetic quality of the procedure was judged by the developments of complications and by patient’s satisfaction. Results: Surgical margins were free in all except 2 cases where the superficial margins were involved and an average 20 months of observation did not show local or systemic relapses. The results of the skin-sparing breast reconstruction are better than other post mastectomy reconstructive techniques for breast final shape, colour, symmetry and the incision scar appearance. Reconstruction was satisfactory for the patients in 67.8%, fair for 17.8% and poor in 14%. Periareolar native skin necrosis appeared in 6 cases but skin healing was satisfactory in all cases. Conclusions: Skin sparing mastectomy is an oncologically safe technique. It is an excellent alternative to total mastectomy and reconstruction in cases not suitable for conservative wide local mastectomy. It offers good shape and symmetry and saves the patients contra lateral breast aesthetic maneuvers and adjuvant irradiation after wide local conservative mastectomy.