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Radical mastectomy: thick vs thin skin flaps

I T Krohn, D R Cooper, J G Bassett

    Archives of Surgery (Chicago, Ill. : 1960)
    |June 1, 1982
    PubMed
    Summary
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    Ultrathin skin flaps in radical mastectomy for breast cancer increased complications like lymphedema and prolonged hospital stays. These flaps did not improve survival rates, suggesting they should not be routinely used.

    Area of Science:

    • Surgical Oncology
    • Breast Cancer Treatment
    • Plastic and Reconstructive Surgery

    Background:

    • Radical mastectomy is a standard surgical procedure for breast cancer.
    • The use of ultrathin skin flaps and autogenous skin grafts is a technique employed in some mastectomy procedures.
    • The impact of ultrathin skin flaps on patient outcomes following mastectomy requires further investigation.

    Purpose of the Study:

    • To compare the outcomes of radical mastectomy using ultrathin skin flaps versus standard skin flaps in women with curable breast cancer.
    • To evaluate the effects of different skin flap techniques on survival rates, local recurrence, wound complications, hospital stay, and lymphedema.

    Main Methods:

    • Retrospective chart review of 45 women treated with radical mastectomy, wide skin excision, ultrathin skin flaps, and skin grafts.

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  • Comparison with a similar cohort of 45 women treated with radical mastectomy, less wide skin excision, and primary wound closure.
  • Statistical analysis of survival, local recurrence, wound complications, hospital stay, and lymphedema rates between the two groups.

    • Main Results:

    • Five- and ten-year survival rates and local recurrence rates were comparable between the ultrathin skin flap group and the standard flap group.
    • The group treated with ultrathin skin flaps experienced significantly higher rates of wound complications, prolonged hospital stays, and subsequent lymphedema.
    • No significant differences in clinical disease staging, age, axillary node metastases, or adjunctive chest-wall irradiation frequency were noted between the groups.

    Conclusions:

    • The routine use of ultrathin skin flaps in radical mastectomy for breast cancer should be abandoned.
    • Standard skin flap techniques with primary wound closure appear to offer comparable oncological outcomes with fewer complications.
    • Minimizing complications such as lymphedema and reducing hospital stay are crucial considerations in breast cancer surgical management.