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Skin-Sparing Mastectomy and Immediate Breast Reconstruction: A Prospective Cohort Study for the Treatment of Advanced Stages of Breast Carcinoma

From the Division of Plastic and Reconstructive Surgery (RDF, JPA, HD) and the Department of Surgery (LJE, ESH), the University of California, San Francisco, California.

Correspondence: Address correspondence and reprint requests to: Robert D. Foster, MD, University of California, San Francisco, Division of Plastic and Reconstructive Surgery, 350 Parnassus Ave., Suite 509, San Francisco, CA 94143-0932; Fax: 415-476-4001; E-mail: fosterr{at}surgery.ucsf.edu

Background: Recent published series demonstrate the safety and effectiveness of skin-sparing mastectomy (SSM) with immediate reconstruction for the treatment of early-stage breast carcinoma. Although several reports have retrospectively evaluated outcomes after breast reconstruction for locally advanced disease (stages IIB and III), no study has specifically considered immediate breast reconstruction after SSM for locally advanced disease.

Methods: From 1996 to 1998, 67 consecutive patients with breast carcinoma underwent SSM with immediate reconstruction and were prospectively observed. From this group of patients, those with locally advanced disease (stage IIB, n = 12; stage III, n = 13) were analyzed separately. Tumor characteristics, adjuvant therapy, type of reconstruction, operative time, complications, hospital stay, and incidence of local recurrence and distant metastasis were noted.

Results: Breast reconstruction consisted of a transverse rectus abdominis myocutaneous flap (n = 22) or a latissimus flap plus an implant (n = 4). The median operative time was 5.5 hours; the average hospital stay was 5.2 days. Complications required reoperation in three patients (12%): partial skin flap necrosis in two and partial abdominal skin necrosis in one. Surgery on the opposite breast for symmetry was required in one patient (4%). Postoperative adjuvant therapy was not significantly delayed (median interval, 32 days). With a median length of follow-up of 49.2 months (range, 33–64 months), local recurrence was present in only one patient (4%), with successful local salvage treatment, and distant metastasis was present in four patients (16%).

Conclusions: SSM with immediate reconstruction seems safe and effective and has a low morbidity for patients with advanced stages of breast carcinoma. Local recurrence rates and the incidence of distant metastasis are not increased compared with those of patients who have had modified radical mastectomies without reconstruction.

Key Words: Skin-sparing mastectomy • Breast reconstruction • Advanced breast cancer

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