ISSN : 2146-3123
E-ISSN : 2146-3131

Favorable Outcome with Close Margins in Patients Undergoing Nipple/Skin Sparing Mastectomy with Immediate Breast Reconstruction: 5-year Follow-up
Enver Özkurt1, Mustafa Tükenmez1, Erdem Güven2, Burcu Çelet Özden2, Gizem Öner1, Mahmut Müslümanoğlu1, Abdullah İğci1, Vahit Özmen1, Seden Küçücük3, Neslihan Cabioğlu1
1Department of General Surgery, Breast Unit, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
2Department of Plastic Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
3Department of Radiation Oncology, İstanbul University İstanbul Institute of Oncology, İstanbul, Turkey
DOI : 10.4274/balkanmedj.2017.0029
Pages : 84-92


Background: Implant-based breast reconstruction after mastectomy has recently been reported to be the preferred type of surgery among breast-specific surgeons and plastic surgeons.
Aims: To explore the significant clinicopathological factors associated with long-term outcome related to local recurrences of the nipple among patients who underwent immediate breast reconstruction with tissue expander or implant after mastectomy.
Study Design: Retrospective cohort.
Methods: From January 2007 to January 2013, 51 breast cancer patients who underwent immediate breast reconstruction with tissue expander or implant were retrospectively analysed. Patients’ demographic data, clinicopathological characteristics, and clinical outcome by disease-free survival and disease-specific survival analyses were determined.
Results: The median follow-up was 64 (31-114) months. Of the 57 mastectomies, 41 were skin sparing mastectomy (72%) and 16 were nipple-areola sparing mastectomy (28%). Immediate breast reconstruction surgery included tissue expander (n=46, 81%) or implant (n=11, 19%) placement. The molecular subgroups of 47 invasive cancers were as follows: luminal A (n=23, 49%), luminal B (n=16, 34%), non-luminal HER2 (n=5, 10.6), triple negative breast cancer (n=3, 6.4%). The 5-years disease-specific survival, disease-free survival, and locoregional recurrence-free survival rates were 96.8%, 90%, and 97.6% respectively. Patients with luminal A cancer were found to have an improved 5-year disease-free survival time than other (luminal A; 100% vs. non-luminal A; 78%; p=0.028). Of the 14 nipple-areola sparing mastectomy, 13 had a close median tumour distance to nipple-areola complex (<20 mm) with a 5-year locoregional recurrence free survival of 100%.
Conclusion: Immediate breast reconstruction with implant or tissue expander can be safely applied in patients undergoing skin sparing mastectomy or nipple-areola sparing mastectomy. Patients with luminal-A type show the most favourable outcome. During the 5-year follow-up period, patients even with close margins (<20 mm) to nipple-areola complex with nipple-areola sparing mastectomy have excellent locoregional and overall survival when treated by contemporary multidisciplinary oncological management.

Keywords : Breast implants, mastectomy, subcutaneous, breast reconstruction, surgical margin, local recurrence
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