Skin sparing mastectomy and immediate breast reconstruction

To evaluate skin sparing mastectomy(SSM) and immediate breast reconstruction(IBR) in terms of the survival, chances of recurrence, aesthetic restoration and prevention of psychosocial problems.

An interventional study.

The Department of Plastic and Reconstructive Surgery, CMH, Rawalpindi from November 1998 to November 2003.

Twenty-eight patients of breast cancer, included in the study, were discussed in a Multidisciplinary Breast Clinic. Detailed metastatic work-up was performed. In all patients SSM with en-bloc level II axillary clearance and IBR was done.

The patients' age ranged between 25-46 years. Two patients (7%) were nullipara. Tumor size was T1 in 10 (36%) and T2 in 18 patients (64%). In all the patients a circum-areolar incision was used. A contralateral uni-pedicled TRAM flap was used in 24 (86%) and latissimus dorsi flap in 4 patients (14%). All the flaps survived completely. There was marginal necrosis of native skin flaps in 03 (10.5%), infection in 03 (10.5%), axillary seroma in 03 (10.5%) and abdominal seroma in 01 patient (3.5%). As late complication 5 patients (19%) developed fat necrosis. Adjuvant chemotherapy was given in 6 (21%) and adjuvant radiotherapy in 4 patients (14%). No recurrence encountered in maximum follow-up . We found an excellent aesthetic restoration in 23 (82%), good in 1 (3.5%) and fair in 4 patients (14%).

SSM for patients with early breast cancer is an oncologically safe procedure. IBR can greatly reduce the psychological trauma associated with breast loss including diminished feelings of feminity, decreased libido, social behavior, sense of mutilation and depression.