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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy
Albert Losken1, Toncred M Styblo, Grant W Carlson
1Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA 30308, USA. albert_Losken@emoryhealthcare.org
Annals of Plastic Surgery
|August 28, 2007
Summary
Therapeutic mammaplasty offers excellent cosmetic outcomes for breast cancer patients, balancing oncologic safety with aesthetic improvement. Younger patients with extensive ductal carcinoma in situ (DCIS) may require delayed reconstruction for optimal results.
Area of Science:
- Oncoplastic surgery
- Breast reconstruction
- Surgical oncology
Background:
- Partial mastectomy defects often result in poor cosmetic outcomes.
- Oncoplastic surgery aims to improve aesthetics while maintaining oncologic safety.
Purpose of the Study:
- To develop a treatment algorithm for partial mastectomy reconstruction.
- To optimize patient selection, diagnosis, margin assessment, and recurrence monitoring.
- To enhance oncologic safety and improve cosmetic results.
Main Methods:
- Retrospective review of patients undergoing partial mastectomy with reduction/mastopexy.
- Reconstruction performed simultaneously or after margin confirmation.
- Analysis of patient demographics, histology, surgical techniques, complications, and outcomes.
Main Results:
- 63 women included: invasive carcinoma (33), DCIS (20), fibroadenoma (6), benign (4).
- Wise pattern used in 84%; superomedial pedicle most common.
- 22% immediate complications; 2% locoregional recurrence rate at 3.25-year follow-up.
- Completion mastectomy needed in 4 patients (extensive DCIS), particularly younger women.
Conclusions:
- Therapeutic mammaplasty effectively preserves shape and symmetry in large/ptotic breasts.
- Versatile techniques accommodate various breast shapes and defect locations.
- Younger patients with extensive DCIS are better candidates for delayed reconstruction.
- Immediate reconstruction is feasible after completion mastectomy without adverse effects.