Hautsparende (skin sparing) Mastektomie mit autologer Sofortrekonstruktion: Onkologische Sicherheit und ästhetische Ergebnisse

 

 Buy Article Permissions and Reprints

Zusammenfassung

Fragestellung: Hat die hautsparende (skin sparing) Mastektomie (SSM) mit autologer Sofortrekonstruktion neben den ästhetischen Vorteilen auch die gleiche onkologische Sicherheit wie die modifiziert radikale Mastektomie (MRM)? Material und Methode: 60 Patientinnen mit T1-2 Mammakarzinomen und Kontraindikationen zur Brusterhaltung wurden mit SSM behandelt und mit 81 gleichaltrigen Patientinnen mit MRM hinsichtlich onkologischer und ästhetischer Parameter verglichen. Bei 33 (55 %) Patientinnen wurde der Nippel-Areola-Komplex (NAC) erhalten. Zur Brustrekonstruktion wurden TRAM- und Latissimus dorsi-Lappen verwandt. Das mittlere follow-up beträgt 40 (range 20-71) Monate. Ergebnisse: Nach SSM traten 3 (5,0 %) und nach MRM 5 (6,2 %) Lokalrezidive auf (p = 0,443). Fernmetastasen und Tod waren mit 26,7 % und 15,0 % (SSM) bzw. 25,9 % und 13,5 % (MRM) nicht signifikant verschieden. Während sich Body-Mass-Index, Operationsdauer und postoperativer Hämoglobinwert in beiden Gruppen signifikant (p < 0,001) unterschieden, war die Komplikationsrate vergleichbar. Das kosmetische Ergebnis nach SSM wurde durch die Patientinnen in 90,0 % und durch die Operateure in 83,4 % als „sehr gut und gut” bewertet. 9 Patientinnen (11,1 %) mit MRM unterzogen sich einer sekundären Brustrekonstruktion. Weitere 12 Patientinnen (14,8 %) würden bei abermaliger Mastektomie eine sofortige Rekonstruktion wünschen. Schlußfolgerung: Die hautsparende Mastektomie führt zu besseren kosmetischen Ergebnissen, ohne die lokale und distante Rezidivrate zu erhöhen. Sie sollte deshalb geeigneten Patientinnen als Alternative zur modifiziert radikalen Mastektomie offeriert werden.

Skin sparing mastectomy and immediate autologeous reconstruction: oncological risks and aesthetic results

Summary

Objective: Is the oncological safety of skin sparing mastectomy (SSM) with immediate autologous reconstruction and improved aesthetic results comparable to postoperative findings in patients treated with modified radical mastectomy (MRM)? Material and methods: Sixty patients with T1-2 breast carcinomas and contraindications for breast conserving therapy were treated by SSM and compared to 81 patients of the same age groups and MRM with regard to oncological and aesthetic data. In 33 (55 %) patients the nipple areola complex (NAC) could be spared. For autologous tissue TRAM- and Latissimus dorsi-flaps were used. The mean follow-up was 40 (range 20-71) months. Results: The observed local recurrence rates were not significantly different (p = 0.443) after SSM (n = 3; 5.0 %) or MRM (n = 5; 6.2 %). Distant metastases and death were seen in 26.7 % and 15.0 % (SSM), respectively, and in 25.9 % and 13.5 % (MRM), respectively. Body mass index, operation time and postoperative haemoglobin concentration differed between both groups significantly (p < 0.001) but not the rate of complications (p = 0.232). Aesthetic results of SSM were judged as excellent or good in 90.0 % of patients and in 83.4 % of surgeons. Nine patients (11.1 %) underwent a secondary breast reconstruction after MRM. Furthermore, 12 (14.8 %) patients with MRM would prefer a SSM with immediate reconstruction in a similar situation. Conclusion: Skin-sparing mastectomy improves aesthetic results to a high degree without increasing of local or distant recurrence rates. Skin-sparing mastectomy should be offered to selected patients with breast cancer as an alternative to modified radical mastectomy.

MeSH

E4.466 mastectomyC4.588.180.520 mammary neoplasms

Literatur

• 1 Cady B. Risk of recurrence after treatment of early breast cancer with skin sparing mastectomy: another editorial perspective [editorial].  Ann Surg Oncol. 1998;  5 103-104
  PubMedGoogle Scholar
• 2 Canadian Association of Radiation Oncologists . Mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer. The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Canadian Association of Radiation Oncologists.  CMAJ. 1998;  158 (Suppl 3) S15-S21
  PubMedGoogle Scholar
• 3 Carlson G W, Bostwick J, Styblo T M. et al . Skin-sparing mastectomy. Oncologic and reconstructive considerations.  Ann Surg. 1997;  225 570-575
  CrossrefPubMedGoogle Scholar
• 4 Dale P S, Giuliano A E. Nipple-areolar preservation during breast-conserving therapy for subareolar breast carcinomas.  Arch Surg. 1996;  131 430-433
  PubMedGoogle Scholar
• 5 Delay E, Gounot N, Bouillot A, Zlatoff A, Rivoire M. Autologous latissimus breast reconstruction: a 3-year clinical experience with 100 patients.  Plast Reconstr Surg. 1998;  102 1461-1478
  CrossrefPubMedGoogle Scholar
• 6 Gerber B, Krause A, Reimer T, Muller H, Friese K. Breast reconstruction with latissimus dorsi flap: improved aesthetic results after transection of its humeral insertion.  Plast Reconstr Surg. 1999;  103 1876-1881
  CrossrefPubMedGoogle Scholar
• 7 Hidalgo D A, Borgen P J, Petrek J A. et al . Immediate reconstruction after complete skin-sparing mastectomy with autologous tissue.  J Am Coll Surg. 1998;  187 17-21
  CrossrefPubMedGoogle Scholar
• 8 Kroll S S, Schusterman M A, Tadjalli H E, Singletary S E, Ames F C. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy.  Ann Surg Oncol. 1997;  4 193-197
  CrossrefPubMedGoogle Scholar
• 9 Laronga C, Kemp B, Johnston D, Robb G L, Singletary S E. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy.  Ann Surg Oncol. 1999;  6 609-613
  CrossrefPubMedGoogle Scholar
• 10 Lopez M J, Porter K A. The current role of prophylactic mastectomy.  Surg Clin North Am. 1996;  76 231-242
  CrossrefPubMedGoogle Scholar
• 11 Santini D, Taffurelli M, Gelli M C. et al . Neoplastic involvement of nipple-areolar complex in invasive breast cancer.  Am J Surg. 1989;  158 399-403
  CrossrefPubMedGoogle Scholar
• 12 Simmons R M, Fish S K, Gayle L. et al . Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies.  Ann Surg Oncol. 1999;  6 676-681
  CrossrefPubMedGoogle Scholar
• 13 Singletary S E. Skin-Sparing Mastectomy and Immediate Breast Reconstruction.  Medscape Womens Health. 1996;  1 2
  PubMedGoogle Scholar
• 14 Singletary S E, Kroll S S. Skin-sparing mastectomy with immediate breast reconstruction.  Adv Surg. 1996;  30 39-52
  PubMedGoogle Scholar
• 15 Slavin S A, Schnitt S J, Duda R B. et al . Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer.  Plast Reconstr Surg. 1998;  102 49-62
  CrossrefPubMedGoogle Scholar
• 16 Toth B A, Forley B G, Calabria R. Retrospective study of the skin-sparing mastectomy in breast reconstruction.  Plast Reconstr Surg. 1999;  104 77-84
  CrossrefPubMedGoogle Scholar
• 17 Toth B A, Lappert P. Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning.  Plast Reconstr Surg. 1991;  87 1048-1053
  CrossrefPubMedGoogle Scholar
• 18 Verheyden C N. Nipple-sparing total mastectomy of large breasts: the role of tissue expansion.  Plast Reconstr Surg. 1998;  101 1494-1500
  PubMedGoogle Scholar
• 19 Verma G R, Kumar A, Joshi K. Nipple involvement in peripheral breast carcinoma: a prospective study.  Indian J Cancer. 1997;  34 1-5
  PubMedGoogle Scholar
• 20 Vyas J J, Chinoy R F, Vaidya J S. Prediction of nipple and areola involvement in breast cancer.  Eur J Surg Oncol. 1998;  24 15-16
  CrossrefPubMedGoogle Scholar

Prof. Dr. med. B. Gerber

Universitätsfrauenklinik

Postfach 10 08 88

D-18055 Rostock