Skin sparing mastectomy and robotic latissimus dorsi-flap reconstruction through a single incision

Abstract

Background: Robotic latissimus dorsi-flap reconstruction (RLDFR) after skin-sparing mastectomy (SSM) for breast cancer (BC) has been performed through a single nipple incision. We report results of SSM with RLDFR, mainly with analysis of feasibility, morbidity, indications, and technique standardization. Methods: We determined characteristics of patients, previous treatment of BC, and type of reconstruction. Surgical technique, duration of surgery, and complication rate were reported according to three successive periods: P1-3. Results: Forty RLDFR, with breast implant for 16 patients, with previous breast radiotherapy in 30% had been performed. In logistic regression, factors significantly associated with duration of surgery ≥ 300 min were P2 (OR 0.024, p = 0.004) and P3 (OR 0.012, p = 0.004) versus P1. The median mastectomy weight was 330 g and 460 g for BMI < and ≥ 23.5 (p = 0.025). Length of hospitalization was 4 days. Total complication rate was 20% (8/40): seven breast complications (four re-operations) and one RLDF complication with re-operation. Periods were significantly predictive of complications (p = 0.045). Conclusion: SSM with RLDFR is feasible, safe, and reproducible. We reported a decrease of duration of surgery, length of post-operative hospitalization, and complication rate.

Mastectomy with immediate breast reconstruction: Results of a mono-centric 4-years cohort

“…This allows a NSM with a unique axillary approach with endoscopic or robotic technic, which is now well determined [ 65 ] but contribution of these procedures in comparison with traditional-NSM must be confirmed by prospective studies with analysis of complication rates, aesthetics advantages and cost efficiency. All recent studies about R-NSM showed that this technic could be performed with a brief learning curve [ [14] , [15] , [16] , [17] , [65] , [66] , [67] ].…”

“…A recent mono-centric study, on 91 Endoscopic-NSM and 40 R-NSM showed that R-NSM is associated with higher satisfaction but at the price of longer operation and higher medical cost [ 66 ] and two studies showed that endoscopic surgery were associated with a better esthetic outcome [ [68] , [69] ]. Robotic-LDF appears as a safe, reproducible and contributive procedure when skin paddle is not required with any dorsal scar and less pain without significant longer procedure [ 15 , 16 ]. This can be explained by the enhanced surgical exposure resulting in the minimization of tissue traction and the resultant tissue trauma and skin necrosis.…”

“…Analyses were performed separately for all complications, breast complications, LDF complications and for endoscopic surgical procedures. Technics of endoscopic NSM and robotic LDF were reported previously [ [15] , [16] , [17] ]. Complication rate was analyzed with Clavien-Dindo grading [ 31 ]: Grade 3 corresponded to any complication which required re-operation and Grade 4 corresponded to severe general infection.…”

“…Reconstruction with implant or latissimus dorsi-flap (LDF) is usually proposed according to patient's wishes, previous treatment, patient's morphology, breast cup-size and ptosis. Moreover, since a few years' robotic mastectomy and or robotic LDF-IBR has been proposed [ [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ].…”

The effect of Modified Radical Mastectomy (MRM) with and without latissimus dorsi flap on seroma of Locally Advanced Breast Cancer (LABC) in Sanglah Hospital

“…A study result by Houvenaeghel G et al, of 16 breast cancer patients who underwent Robotic Latissimus Dorsi-Flap Reconstruction (RLDFR) stated that RLDFR was feasible, safe, and can be done, especially in reducing the duration of the surgery, postoperative length of stay, and complication rates. 15 The decline in shoulder function causes shoulder movement that is performed after prolonged immobilization. A study by Sampathraju S et al, supported this theory that early active shoulder movements after surgery have a higher incidence of seroma formation than shoulder movements that are performed later on.…”