Advertisement

World Journal of Surgery

, Volume 34, Issue 9, pp 2197–2203 | Cite as

Clinical Outcomes of Video-Assisted Skin-Sparing Partial Mastectomy for Breast Cancer and Immediate Reconstruction with Latissimus Dorsi Muscle Flap as Breast-Conserving Therapy

  • Hiroo NakajimaEmail author
  • Ikuya Fujiwara
  • Naruhiko Mizuta
  • Koichi Sakaguchi
  • Mahiro Ohashi
  • Asako Nishiyama
  • Yoshimi Umeda
  • Miho Ichida
  • Junji Magae
Article

Abstract

Background

Skin-sparing partial mastectomy (SSPM) has yet to be investigated as a breast-conserving therapy for early-stage breast cancer. We report the clinical outcomes for video-assisted SSPM (VA-SSPM) with immediate breast reconstruction using autogenous tissue.

Methods

VA-SSPM is indicated for early-stage breast cancer arising in the upper-outer or lower-outer quadrant without skin involvement. An incision is placed along the midaxillary line, and SSPM is performed under endoscopic guidance using subcutaneous tunneling and lifting methods. Through the same incision, a latissimus dorsi muscle flap is harvested for breast reconstruction. From January 2000 to October 2007, 168 patients (Tis, n = 24; T1, n = 37; T2, n = 107) underwent VA-SSPM, and morbidity, curability, and postoperative patient satisfaction were investigated.

Results

Postoperative complications included skin necrosis (2.4%, n = 4) and muscle flap necrosis (0.6%, n = 1), but no severe complications were observed. After a mean follow-up of 58.6 months, eight patients (4.8%) experienced local recurrence. Sixty-month distant metastasis-free survival rates for Tis, T1, and T2 were 100%, 97%, and 83.3%, respectively, with an overall rate of 88.4%. Furthermore, overall survival rates for Tis, T1, and T2 were 100%, 94.1%, and 94.4%, respectively, with an overall survival rate of 95% for all patients. A patient satisfaction survey showed that 81.6% of patients evaluated the surgery as “good.”

Conclusions

VA-SSPM for early-stage breast cancer improves cosmetic results and achieves high patient satisfaction without increasing local or distant organ recurrence. This method offers a useful local therapy for early-stage breast cancer.

Keywords

Mammary Gland Sentinel Lymph Node Biopsy Partial Mastectomy Transverse Rectus Abdominis Myocutaneous Endoscopic Guidance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflicts of interest statement

The authors received no financial support for the present study and declare no conflicts of interest.

References

  1. 1.
    Slavin SA, Schniit SJ, Duda RB et al (1998) Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early stage breast cancer. Plast Reconstr Surg 102:49–62CrossRefPubMedGoogle Scholar
  2. 2.
    Simmons RM, Fish SK, Gayle L et al (1999) Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies. Ann Surg Oncol 6:676–681CrossRefPubMedGoogle Scholar
  3. 3.
    Rivadeneira DE, Simmons RM, Fish SK et al (2000) Skin-sparing mastectomy with immediate breast reconstruction: a critical analysis of local recurrence. Cancer J 6:331–335PubMedGoogle Scholar
  4. 4.
    Foster RD, Esserman LJ, Anthony JP et al (2002) Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast carcinoma. Ann Surg Oncol 9:462–466CrossRefPubMedGoogle Scholar
  5. 5.
    Greenway RM, Schlossberg L, Dooley WC (2005) Fifteen-year series of skin-sparing mastectomy for stage 0 to 2 breast cancer. Am J Surg 190:918–922CrossRefPubMedGoogle Scholar
  6. 6.
    Salhab M, Al Sarakbi W, Joseph A et al (2006) Skin-sparing mastectomy and immediate breast reconstruction: patient satisfaction and clinical outcome. Int J Clin Oncol 11:51–54CrossRefPubMedGoogle Scholar
  7. 7.
    Sacchini V, Pinotti JA, Barros AC et al (2006) Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg 203:704–714CrossRefPubMedGoogle Scholar
  8. 8.
    Vaughan A, Dietz JR, Aft R et al (2007) Patterns of local breast cancer recurrence after skin-sparing mastectomy and immediate breast reconstruction. Am J Surg 194:438–443CrossRefPubMedGoogle Scholar
  9. 9.
    Drucker-Zertuche M, Robles-Vidal C (2007) A 7-year experience with immediate breast reconstruction after skin sparing mastectomy for cancer. Eur J Surg Oncol 33:140–146CrossRefPubMedGoogle Scholar
  10. 10.
    Meretoja TJ, Rasia S, von Smitten KA et al (2007) Late results of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg 94:1220–1225CrossRefPubMedGoogle Scholar
  11. 11.
    Singletary SE, Robb GL (2003) Oncologic safety of skin-sparing mastectomy. Ann Surg Oncol 10:95–97CrossRefPubMedGoogle Scholar
  12. 12.
    Cunnick GH, Mokbel K (2004) Skin-sparing mastectomy. Am J Surg 188:78–84CrossRefPubMedGoogle Scholar
  13. 13.
    Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232CrossRefPubMedGoogle Scholar
  14. 14.
    Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241CrossRefPubMedGoogle Scholar
  15. 15.
    Jacobson JA, Danforth DN, Cowan KH et al (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332:907–911CrossRefPubMedGoogle Scholar
  16. 16.
    van Dongen JA, Voogd AC, Fentiman IS et al (2000) Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 92:1143–1150CrossRefPubMedGoogle Scholar
  17. 17.
    Komoike Y, Akiyama F, Iino Y et al (2006) Ipsilateral breast tumor recurrence (IBTR) after breast-conserving treatment for early breast cancer: risk factors and impact on distant metastases. Cancer 106:35–41CrossRefPubMedGoogle Scholar
  18. 18.
    Nakajima H, Sakaguchi K, Mizuta N et al (2002) Video-assisted total glandectomy and immediate reconstruction for breast cancer. Biomed Pharmacother 56:205s–208sCrossRefPubMedGoogle Scholar
  19. 19.
    Tamaki Y, Nakano Y, Sekimoto M et al (1998) Transaxillary endoscopic partial mastectomy for comparatively early-stage breast cancer. An early experience. Surg Laparosc Endosc 8:308–312CrossRefPubMedGoogle Scholar
  20. 20.
    Tamaki Y, Sakita I, Miyoshi Y et al (2001) Transareolar endoscopy-assisted partial mastectomy: a preliminary report of six cases. Surg Laparosc Endosc Percutan Tech 11:356–362CrossRefPubMedGoogle Scholar
  21. 21.
    Thomson HJ, Potter S, Greenwood RJ et al (2008) A prospective longitudinal study of cosmetic outcome in immediate latissimus dorsi breast reconstruction and the influence of radiotherapy. Ann Surg Oncol 15:1081–1091CrossRefPubMedGoogle Scholar
  22. 22.
    Patani N, Devalia H, Anderson A et al (2008) Oncological safety and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction. Surg Oncol 17:97–105CrossRefPubMedGoogle Scholar
  23. 23.
    Hunt KK, Baldwin BJ, Strom EA et al (1997) Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction. Ann Surg Oncol 4:377–384CrossRefPubMedGoogle Scholar
  24. 24.
    Hernanz F, Regaño S, Redondo-Figuero C et al (2007) Oncoplastic breast-conserving surgery: analysis of quadrantectomy and immediate reconstruction with latissimus dorsi flap. World J Surg 31:1934–1940CrossRefPubMedGoogle Scholar
  25. 25.
    Gerber B, Krause A, Reimer T et al (2003) Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 238:120–127CrossRefPubMedGoogle Scholar
  26. 26.
    Benediktsson KP, Perbeck L (2008) Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg Oncol 34:143–148PubMedGoogle Scholar
  27. 27.
    Goldhirsch A, Glick JH, Gelber RD et al., Panel members (2005) Meeting highlights: international expert consensus on the primary therapy of early breast cancer. Ann Oncol 16:1569–1583Google Scholar
  28. 28.
    NCCN Clinical Practice Guidelines in Oncology Breast Cancer v.2 (2008) http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf. Accessed 1 May 2008
  29. 29.
    Pomel C, Missana MC, Atallah D et al (2003) Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Eur J Surg Oncol 29:127–131CrossRefPubMedGoogle Scholar
  30. 30.
    Pezner RD, Patterson MP, Hill LR et al (1985) Breast retraction assessment: an objective evaluation of cosmetic results of patients treated conservatively for breast cancer. Int J Radiat Oncol Biol Phys 11:575–578PubMedGoogle Scholar
  31. 31.
    Al-Ghazal SK, Blamey RW (1999) Cosmetic assessment of breast-conserving surgery for primary breast cancer. Breast 8:162–168CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Hiroo Nakajima
    • 1
    Email author
  • Ikuya Fujiwara
    • 1
    • 2
  • Naruhiko Mizuta
    • 1
  • Koichi Sakaguchi
    • 1
  • Mahiro Ohashi
    • 1
  • Asako Nishiyama
    • 1
  • Yoshimi Umeda
    • 1
  • Miho Ichida
    • 1
  • Junji Magae
    • 3
  1. 1.Department of Endocrine, Breast SurgeryKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Translational Cancer Drug DevelopmentKyoto Prefectural University of MedicineKyotoJapan
  3. 3.Radiation Safety Research Center, Nuclear Technology Research LaboratoryCentral Research Institute of Electric Power IndustryTokyoJapan

Personalised recommendations