scholarly journals Types of Mastectomies and Immediate Reconstructions for Ipsilateral Breast Local Recurrences

2020 ◽  
Vol 10 ◽  
Author(s):  
Pauline Simon ◽  
Julien Barrou ◽  
Monique Cohen ◽  
Sandrine Rua ◽  
Eric Lambaudie ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Local Recurrence ◽  
Complication Rate ◽  
Rare Event ◽  
Immediate Breast Reconstruction ◽  
Good Choice ◽  
Ipsilateral Breast ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Salvage Mastectomy

Purpose: Ipsilateral-breast-local-recurrence (ILBLR) is a rare event with little data on immediate-breast-reconstruction (IBR). We report post-operative results of different types of mastectomy for ILBLR with or without IBR performed during a period of 40 months in order to analyze post-operative complications as main objective.Methods: We analyzed mastectomies performed for ILBLR after initial breast conservative treatment from January 2016 to April 2019. The characteristics of patients, surgery, complication rate, postoperative hospitalization have been determined.Results: Of the 207 mastectomies, 32.8% had an IBR: 31 nipple-sparing-mastectomy (NSM) and 37 skin-sparing-mastectomy (SSM) with 37 latissimus-dorsi-flap (LDF) IBR and 31 implant-IBR. Few reconstruction was performed for patients with body-mass-index ≥30 (OR = 0.214), infiltrating ductal carcinomas (OR = 0.272) and ASA-3 patients (OR = 0.254). In multivariate analysis, LDF-IBR was more often realized for NSM and for patients with BMI ≥25. The overall complication rate was 37.4%: 45.6 and 33.1% with and without IBR, respectively (p = 0.056). In multivariate analysis, BMI ≥25 (OR 2.02, p = 0.023), IBR (OR 1.9, p = 0.046) and tobacco (OR 2.17, p = 0.055) were correlated with higher risk of complications. There was no difference for Grade 2–3 complications rates for IBR and no IBR, respectively (14.7%: 10/68 and 9.3%: 13/139). In multivariate analysis, overall survival from date of mastectomy for local recurrence was significantly associated with interval time to local recurrence (OR 6.981).Conclusion: Salvage mastectomy and IBR is a good choice for ILBLR, particularly using flap reconstruction. NSM can be considered as a good option in selected patients for ILBLR for NSM and/or LDFR.

Robotic Nipple-Sparing Mastectomy and Immediate Breast Reconstruction With Robotic Latissimus Dorsi Flap Harvest: Technique and Results

2020 ◽  
pp. 155335062091791
Author(s):  
Gilles Houvenaeghel ◽  
Monique Cohen ◽  
Sandrine Rua Ribeiro ◽  
Julien Barrou ◽  
Mellie Heinemann ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Complication Rate ◽  
Surgical Procedure ◽  
Latissimus Dorsi ◽  
Immediate Breast Reconstruction ◽  
Latissimus Dorsi Flap ◽  
Axillary Lymph ◽  
Grade 3 ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Introduction. Only few cases of robotic latissimus dorsi flap reconstruction (RLDFR) have been reported in indication of reconstruction for breast cancer (BC). We report our experience of combined robotic nipple-sparing mastectomy (R-NSM) and RLDFR, and analyze technique, indications, and reproducibility. Methods. All patients with R-NSM and RLDFR from November 2016 to August 2, 2018, were analyzed, and technics have been described. Complication rate with Clavien-Dindo grading and postoperative hospitalization length (days) are reported. Results. Thirty-five R-NSM with RLDFR were performed in 22 cases for primitive BC and 13 for local recurrence. In 12 patients, another surgical procedure was performed during the same time (axillary lymph node dissection or contralateral breast surgery). R-NSM was realized through a short axillar incision, with inside-only installation for 12 patients (34.3%): 18 nonautologous and 17 autologous RLDFR associated with implant in 9 patients. In logistic regression, mastectomy weight >330 g was significantly associated with the use of implant (odds ratio [OR] = 17, P = .015), and significant factor of the time of anesthesia ≥380 minutes was 2 installations (OR = 10.4, P = .049). The median duration of hospitalization stay was 4 days. Complications rates were 51.4% (18/35; 9 grade-1, 2 grade-2, and 7 grade-3). In logistic regression, associated other surgical procedure was predictive of grade-3 complications (OR = 6.87, P = .053). Conclusion. We confirmed the reproducibility and safety of R-NSM and RLDFR with a decreased complication rate. NSM was performed in 42.8% of our patients after previous radiotherapy. We observed an increase of grade-3 complications when R-NSM and RLDFR was combined to another surgical procedure.

scholarly journals Robotic Versus Conventional Nipple-Sparing Mastectomy With Immediate Breast Reconstruction

2021 ◽  
Vol 11 ◽  
Author(s):  
Gilles Houvenaeghel ◽  
Julien Barrou ◽  
Camille Jauffret ◽  
Sandrine Rua ◽  
Laura Sabiani ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Complication Rate ◽  
Immediate Breast Reconstruction ◽  
Predictive Score ◽  
Patient’S Satisfaction ◽  
Duration Of Surgery ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Complications Rate ◽  
Length Of Hospitalization

BackgroundSeveral studies reported the feasibility and safety of robotic-NSM (R-NSM). The aim of our prospective study was to compare R-NSM and conventional-NSM (C-NSM).MethodsWe analyzed patients who were operated on with and without robotic assistance (R-NSM or C-NSM) and who received immediate breast reconstruction (IBR) with implant or latissimus dorsi-flap (LDF). The main objective was complication rate and secondary aims were post-operative length of hospitalization (POLH), duration of surgery, and cost.ResultsWe analyzed 87 R-NSM and 142 C-NSM with implant-IBR in 50 and 135 patients, with LDF-IBR in 37 and 7 patients, respectively. Higher durations of surgery and costs were observed for R-NSM, without a difference in POLH and interval time to adjuvant therapy between R-NSM and C-NSM. In the multivariate analysis, R-NSM was not associated with a higher breast complication rate (OR=0.608) and significant factors were breast cup-size, LDF combined with implant-IBR, tobacco and inversed-T incision. Grade 2-3 breast complications rate were 13% for R-NSM and 17.3% for C-NSM, significantly higher for LDF combined with implant-IBR, areolar/radial incisions and BMI>=30. A predictive score was calculated (AUC=0.754). In logistic regression, patient’s satisfaction between C-NSM and R-NSM were not significantly different, with unfavorable results for BMI >=25 (OR=2.139), NSM for recurrence (OR=5.371) and primary breast cancer with radiotherapy (OR=4.533). A predictive score was calculated. In conclusion, our study confirms the comparable clinical outcome between C- NSM and R-NSM, in the price of longer surgery and higher cost for R-NSM. Predictive scores of breast complications and satisfaction were significantly associated with factors known in the pre-operative period.

scholarly journals Evaluation of result of skin-nipple sparing mastectomy in Baghdad Teaching Hospital and Dijla Private Hospital

2018 ◽  
Vol 5 (9) ◽  
pp. 3002
Author(s):  
Sabah Noori Abdulraheem Al-Khazaali ◽  
Rafea Jasim Hussein Al-Shammari
Keyword(s):  
Local Recurrence ◽  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
Clinical Feature ◽  
Characteristic Type ◽  
Aesthetic Result ◽  
Nipple Sparing Mastectomy ◽  
One Year ◽  
Nipple Sparing

Background: Skin-nipple sparing mastectomy and immediate breast reconstruction by silicone implantation has become increasingly popular as an effective treatment for patients with breast carcinoma. The aim of this study was to evaluate the results of skin-nipple sparing mastectomy.Methods: Records of twenty-seven patients with operable breast cancer who had skin-nipple sparing mastectomy and immediate breast reconstruction between June 2009 and June 2011 were reviewed. Patients and tumor characteristic, type of reconstruction, post-operative complication, aesthetics, results and incidence of recurrence analyzed.Results: Mean age of 37 patients, aged 25 to 48 years old. Regarding the clinical feature, the size of mass <3 cm in 70%, the site of mass in upper outer quadrant in 62%, no case of skin changes and/or nipple changes. There are two cases of all patients which fixed to underlying tissues about 63% of cases are grade II, stage II and 37% are grade I, stage I. The results of follow up of the procedures are: seroma developed in 14%, infection 3.5%, skin necrosis 7%, local recurrence was zero for follow up for more than one year, about 63% received chemotherapy.Conclusions: S.N.S.M. and immediate breast reconstruction with silicon implantation for selective case of CA breast is associated with low morbidity and low rate of local recurrence and good aesthetic result with patient satisfaction.

scholarly journals Robotic nipple-sparing mastectomy complication rate compared to traditional nipple-sparing mastectomy: a systematic review and meta-analysis

2021 ◽  
Author(s):  
M. D. Filipe ◽  
E. de Bock ◽  
E. L. Postma ◽  
O. W. Bastian ◽  
P. P. A. Schellekens ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Complication Rate ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Complication Rates ◽  
Flap Necrosis ◽  
Postoperative Complication Rate ◽  
Common Cancer ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

AbstractBreast cancer is worldwide the most common cause of cancer in women and causes the second most common cancer-related death. Nipple-sparing mastectomy (NSM) is commonly used in therapeutic and prophylactic settings. Furthermore, (preventive) mastectomies are, besides complications, also associated with psychological and cosmetic consequences. Robotic NSM (RNSM) allows for better visualization of the planes and reducing the invasiveness. The aim of this study was to compare the postoperative complication rate of RNSM to NSM. A systematic search was performed on all (R)NSM articles. The primary outcome was determining the overall postoperative complication rate of traditional NSM and RNSM. Secondary outcomes were comparing the specific postoperative complication rates: implant loss, hematoma, (flap)necrosis, infection, and seroma. Forty-nine studies containing 13,886 cases of (R)NSM were included. No statistically significant differences were found regarding postoperative complications (RNSM 3.9%, NSM 7.0%, p = 0.070), postoperative implant loss (RNSM 4.1%, NSM 3.2%, p = 0.523), hematomas (RNSM 4.3%, NSM 2.0%, p = 0.059), necrosis (RNSM 4.3%, NSM 7.4%, p = 0.230), infection (RNSM 8.3%, NSM 4.0%, p = 0.054) or seromas (RNSM 3.0%, NSM 2.0%, p = 0.421). Overall, there are no statistically significant differences in complication rates between NSM and RNSM.

scholarly journals Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Avra S. Laarakker ◽  
Audrey Rich ◽  
Jeffrey Wu ◽  
Stephanie Fine
Keyword(s):  
Case Report ◽  
Fluid Collection ◽  
Nipple Discharge ◽  
Rare Event ◽  
Silicone Implants ◽  
Complication Rates ◽  
Reconstructive Procedures ◽  
First Case ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Abstract Background Rates of nipple-sparing mastectomies have increased over the past decade. In 2017, acellular dermal matrix was used in 56% of breast reconstructive procedures, with complication rates similar to operations without AlloDerm. Although persistent nipple discharge after nipple-sparing mastectomy is a rare event, it has been described in the literature. Other authors have described evaluation and treatment on a case-by-case basis. To the best of our knowledge, this is the first case report to describe a persistent unilateral discharge after multiple operative revisions and to provide an algorithmic approach to workup and treatment. Case presentation We present a case of a 29-year-old Hispanic woman with BRCA1 mutation who underwent a prophylactic bilateral nipple-sparing mastectomy with immediate reconstruction using AlloDerm. The year following her operation, the patient underwent two surgical revisions, one for implant rippling and one for asymmetry. Six months after her second revision, she presented to our hospital with a capsular contracture and unilateral clear nipple discharge. Her breast ultrasound showed dilated subareolar ducts and a suspicious mass. Magnetic resonance imaging identified a benign-appearing, rim-enhancing fluid collection. She underwent a third revision. One year later, she returned to our clinic with bloody nipple discharge, erythematous skin changes, and a palpable breast lump. Her surgical biopsy showed a fold in AlloDerm and chronic inflammatory changes. She continued experiencing discharge and opted for nipple excision. During the operation, a lacrimal probe demonstrated a direct connection between the discharging external duct and a seroma associated with an area of unincorporated AlloDerm. The section of unincorporated AlloDerm was excised, and no evidence of malignancy was identified. Ten months later, the patient remained symptom-free and had progressed to placement of final silicone implants. Conclusions To the best of our knowledge, this is the first case report to describe a nongravid patient with persistent unilateral sanguineous nipple discharge after multiple operative revisions. A visible communication between the draining duct and a seroma associated with unincorporated AlloDerm was ultimately identified. We present a clinical algorithm for patients with nipple discharge after nipple-sparing mastectomy.

scholarly journals Robot-assisted Nipple-sparing Mastectomy with Immediate Breast Reconstruction: An Initial Experience

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Hyung Seok Park ◽  
Jeea Lee ◽  
Dong Won Lee ◽  
Seung Yong Song ◽  
Dae Hyun Lew ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Learning Curve ◽  
Operation Time ◽  
Immediate Breast Reconstruction ◽  
Robot Assisted ◽  
Open Conversion ◽  
Areolar Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Abstract Seeking smaller and indistinct incisions, physicians have attempted endoscopic breast surgery in breast cancer patients. Unfortunately, there are some limitations in the range of movement and visualization of the operation field. Potentially addressing these limitations, we investigated the outcomes of gas and gasless robot-assisted nipple-sparing mastectomy (RANSM) with immediate breast reconstruction (IBR). Ten patients underwent 12 RANSM with IBR between November 2016 and April 2018. Patients with tumors measuring >5 cm in diameter, tumor invasion of the skin or nipple-areolar complex, proven metastatic lymph nodes, or planned radiotherapy were excluded. Age, breast weight, diagnosis, tumor size, hormone receptor status, and operation time were retrospectively collected. Postoperative outcomes including postoperative complications and final margin status of resected were analyzed. The median total operation time and console time were 351 min (267–480 min) and 51 min (18–143 min), respectively. The learning curve presented as a cumulative sum graph showed that the console time decreased and then stabilized at the eighth case. There was no open conversion or major postoperative complication. One patient had self-resolved partial nipple ischemia, and two patients experienced partial skin ischemia. We deemed that RANSM with IBR is safe and feasible for early breast cancer, benign disease of the breast, and BRCA 1/2 mutation carriers. RANSM is an advanced surgical method with a short learning curve.

Sign in / Sign up

Export Citation Format

Share Document