SKIN-SPARING MASTECTOMY WITH IMMEDIATE BREAST RECONSTRUCTION - THE M-D-ANDERSON-CANCER-CENTER EXPERIENCE

Background: Skin-sparing mastectomy with immediate reconstruction has become popular with patients because, compared with delayed reconstruc tion, it improves the cosmetic result, reduces cost and anesthetic ris k, and in one stage completes most of the surgical treatment that the patient will ever require for treatment of her breast cancer. In the p ast, reconstruction was often delayed because of an unwarranted fear o f locoregional recurrence or because the patient, having to live for s ome time with a flat chest wall, would be more appreciative of her rec onstruction. This concept is now considered unacceptable, and many wom en regard this attitude as evidence of a lack of concern for the psych ological impact of mastectomy. Method: Provided that the breast skin i s not involved with or close to the tumor, we prefer to perform the ma stectomy with removal of only the nipple-areolar complex and the tumor biopsy scar. The mastectomy is otherwise the same as a standard modif ied radical mastectomy with removal of all breast tissue and a level I -II axillary node dissection. Our preference is to use the transverse rectus abdominis myocutaneous flap with a microvascular anastomosis be cause it provides a better blood supply, reduces abdominal wall muscle sacrifice, and eliminates the bulge from tunneling required by a pedi cled flap. Result: Using the skin-sparing technique with immediate rec onstruction in 545 patients with early-stage breast cancer, our overal l incidence of regional recurrence was 2.6%, Of 95 patients who were f ollowed for >four years, the recurrence rate was 4.2%. Conclusions: Re gional recurrence after skin-sparing mastectomy is a function of the b iology of the tumor and the stage of the disease and is not affected b y the use of immediate reconstruction or skin-preservation mastectomy.