Long-term outcomes of patients with breast cancer after nipple-sparing mastectomy/skin-sparing mastectomy followed by immediate transverse rectus abdominis musculocutaneous flap reconstruction

Lee, Sae Byul; Lee, Jong Won; Kim, Hee Jeong; Ko, Beom Seok; Son, Byung Ho; Eom, Jin Sup; Lee, Taik Jong; Ahn, Sei-Hyun

doi:10.1097/md.0000000000010680

Cited by 16 publications

(35 citation statements)

References 43 publications

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“…A total of 457 publications were identified through PubMed and CENTRAL search using the keywords, of which 19 were eligible for inclusion in the final analysis (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). The PRISMA flow chart is presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Pattern of local recurrence after mastectomy and reconstruction in breast cancer patients: a systematic review

Joo¹,

Ki²,

Kim³

et al. 2021

Gland Surg

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Background: This study aimed to describe the locations of local recurrences based on the mastectomy and reconstruction type in breast cancer patients.Methods: In November 2020, a systematic literature review was performed through MEDLINE/PubMed and the Cochrane Centre Register of Controlled Trials. Publications that included skin-sparing or nipplesparing mastectomy followed by breast reconstruction and described the location of local recurrences were analyzed. Exclusion criteria included salvage or prophylactic mastectomy, unclear distinction between local and regional recurrences, rare tumor types.Results: From 19 publications, 272 local recurrences lesions were reported in a total of 4,787 patients.After autologous reconstruction (n=2,465), local recurrences were located in the skin in 45 (1.8%) patients, in the chest wall in 18 (0.7%), and in the nipple-areolar complex in 9 (0.4%). After implant reconstruction (n=1,917), local recurrences sites included the skin in 91 (4.7%) patients, chest wall in 8 (0.4%), and nippleareolar complex in 8 (0.4%). Of the 70 lesions with reported in-breast location, 57 (81.4%) relapsed in the original tumor location.Discussion: Although meta-analysis was not conducted, present analysis demonstrated that most local recurrences after skin-sparing or nipple-sparing mastectomy occurred within the skin or subcutaneous tissues. It was found that the original tumor location was the most frequent site of relapse. Therefore, special attention should be paid to the original tumor overlying the skin while planning postmastectomy radiation therapy.

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Section: Resultsmentioning

confidence: 99%

Pattern of local recurrence after mastectomy and reconstruction in breast cancer patients: a systematic review

Joo¹,

Ki²,

Kim³

et al. 2021

Gland Surg

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“…However, to date, no randomized controlled data on the differences in the oncologic safety between mastectomy with breast reconstruction and without breast reconstruction or the oncologic outcomes of different reconstruction methods is available due to ethical concerns. Most existing studies based on retrospective data have documented that both IBR and AFR did not increase the risk of breast cancer recurrence [8][9][10][11][12]. However, con icting results have indicated that postmastectomy AFR has an increased risk of cancer recurrence compared with mastectomy alone [25].…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, postmastectomy reconstruction options mainly include implant-based reconstruction (IBR) and autologous ap reconstruction (AFR) in the current clinical practice. Previous studies have demonstrated that breast reconstruction using either implants or autologous tissue does not increase the risk of breast cancer recurrence compared to conventional mastectomy without reconstruction [8][9][10][11][12]. However, few studies have compared breast cancer outcomes between the IBR and AFR [13].…”

Section: Introductionmentioning

confidence: 99%

Breast Cancer Outcomes Following Immediate Breast Reconstruction with Implants Versus Autologous Flaps: A Propensity Score-Matched Study

Han

Kim

et al. 2021

Preprint

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Purpose A large proportion of patients with breast cancer who had mastectomy had undergone breast reconstruction with implants or autologous flaps. However, only a few studies have compared the breast cancer outcomes between the implant-based reconstruction (IBR) and autologous flap reconstruction (AFR). In this study, we retrospectively compared the local recurrence rates, distant metastasis rates, and survival outcomes between immediate IBR and AFR. Methods A total of 1530 patients with primary breast cancer who underwent IBR or AFR with nipple-/skin-sparing mastectomy were included. Patients who underwent neoadjuvant systemic therapy were excluded from the study. After propensity score matching by age at diagnosis, T stage, N stage, molecular subtype, mastectomy type, adjuvant radiotherapy status, and follow-up period, 938 patients were 1:1 matched, comprising the well-balanced IBR and AFR groups. Locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and breast cancer-specific survival (BCSS) were compared between the matched groups. Results After matching, the median follow-up periods were 68 months and 71 months for the IBR and AFR groups, respectively. No significant differences were observed between the IBR and AFR groups regarding the local recurrence (7.2% vs. 5.1%; P = 0.175), regional recurrence (2.1% vs. 1.5%; P = 0.463), or distant metastasis (3.2% vs. 3.2%; P = 1.000) rates. Moreover, no significant difference was observed between the IBR and AFR groups in the LRRFS (hazard ratio, 0.691; 95% CI, 0.433–1.102; P = 0.118), DFS (hazard ratio, 0.709; 95% CI, 0.468–1.076; P = 0.104), DMFS (hazard ratio, 1.006; 95% CI, 0.491–2.059; P = 0.987), or BCSS (hazard ratio, 0.445; 95% CI, 0.111–1.786; P = 0.659). Conclusion In this propensity score-matched analysis of oncologic outcomes in patients with primary breast cancer who underwent immediate breast reconstruction with nipple-/skin-sparing mastectomy, no significant differences were observed between the IBR and AFR groups.

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“…The study conducted by Lee et al [24] on immediate transverse rectus abdominis musculocutaneous flap reconstruction in breast cancer patients was exclusively based on oncological safety, while our study involved a comparison of TRAM flap with silicone implants. In our study we took the distance of the breast cancer tumor from the NAC as the main component.…”

Section: Discussionmentioning

confidence: 99%

“…We also evaluated the patient satisfaction level, as we know that this affects the clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality healthcare; however, in the study conducted by Lee et al [24] the patient satisfaction level was not considered. Our study is also based on the INCISION prospectus, we used lateral incision in all the cases and immediate reconstruction of the breast was performed using the autologous graft.…”

Section: Discussionmentioning

confidence: 99%

Skin- and Nipple-Areola-Sparing Mastectomy with Immediate Breast Reconstruction Using Transverse Rectus Abdominis Myocutaneous Flap and Silicone Implants in Breast Carcinoma Patients

Wang

2020

Oncol Res Treat

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Background: We aimed to assess patient satisfaction and aesthetic outcome in breast cancer patients undergoing nipplesparing mastectomy (NSM) and immediate breast reconstruction. Materials and Methods: The study population comprised 215 patients with histopathologically diagnosed breast cancer. The inclusion criteria were as follows: a diagnosis of breast cancer, a tumor of any size, any stage of nodal metastasis, and a tumor margin > 2.0 cm from the margin of the nipple-areola complex. To measure the aesthetic outcome, the Lowery scale was used. After mastectomy, immediate breast reconstruction was performed using the transverse rectus abdominis myocutaneous (TRAM) flap, and by pacing the silicone implant. Results: Most of the patients were aged between 40 and 51 years. Lymphadenopathy was positive in 87 out of 215 subjects; among these 87 subjects, 61 showed macrometastasis and 26 micrometastasis. A lateral incision was performed for mastectomy in all cases, and immediate breast reconstruction was performed using autologous grafts: the latissimus dorsi myocutaneous (TRAM) flap in 83% of cases, and silicone implants in 17% of cases were used for reconstruction. An excellent aesthetic outcome was seen in 70% of the cases, and 22% showed a good outcome. Conclusions: NSM is a very safe and technically feasible procedure that provides a high level of patient satisfaction and an excellent aesthetic outcome.

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Long-term outcomes of patients with breast cancer after nipple-sparing mastectomy/skin-sparing mastectomy followed by immediate transverse rectus abdominis musculocutaneous flap reconstruction

Cited by 16 publications

References 43 publications

Pattern of local recurrence after mastectomy and reconstruction in breast cancer patients: a systematic review

Pattern of local recurrence after mastectomy and reconstruction in breast cancer patients: a systematic review

Breast Cancer Outcomes Following Immediate Breast Reconstruction with Implants Versus Autologous Flaps: A Propensity Score-Matched Study

Skin- and Nipple-Areola-Sparing Mastectomy with Immediate Breast Reconstruction Using Transverse Rectus Abdominis Myocutaneous Flap and Silicone Implants in Breast Carcinoma Patients

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