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Mastectomy by Inverted Drip Incision and Immediate Reconstruction: Data From 510 Cases

From the Departments of Surgical Oncology (ANVG, CMEC, AMME, MMEM-P) and Statistics (PIMS), Erasmus Medical Center/Daniel den Hoed Cancer Clinic; and Department of Plastic Surgery (RTJW), Zuiderziekenhuis, Rotterdam, The Netherlands.

Correspondence: Address correspondence and reprint requests to: Albert N. van Geel, MD, PhD, Department of Surgical Oncology, Erasmus Medical Center/Daniel den Hoed Cancer Clinic, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands; Fax: 31-10-4391011; E-mail: anvangeel{at}erasmusmc.nl

Background: Immediate reconstruction of the breast can be performed in selected cases after mastectomy for breast cancer or after prophylactic mastectomy in patients with a high risk of developing breast cancer. Despite the frequency with which these procedures are performed, data from large series of subpectoral implantation of silicone prostheses in combination with a skin-saving approach are lacking.

Methods: In this retrospective study, data on complications and late surgical interventions in 356 patients who underwent 510 mastectomies with an inverted drip incision and immediate reconstruction (MIDIIR) were analyzed to determine potential prognostic factors of early complications.

Results: In 82% of the MIDIIRs, the postoperative course was uneventful. In 18%, the complications were infection (32 cases), necrosis of the skin flap (29 cases), bleeding (31 cases), and protrusion of the prosthesis (20 cases), resulting in surgery in 9, 12, 15, and 20 cases, respectively. At the end of the follow-up period, 30 (6%) prostheses were definitively removed. Age, size of the prostheses, radiotherapy, previous lumpectomy, and indication for mastectomy were not significant factors for the prognosis of early complications.

Conclusions: With the right technique and indications, MIDIIR is a very safe procedure and should be one of the surgical treatments that can be offered in the overall management of patients with, or at high risk for, breast cancer.

Key Words: Breast cancer • Mastectomy • Reconstruction • Silicone prosthesis • Skin-sparing incision • Complications

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