E. E. Burke1, C. Laronga1, W. Sun1, B. J. Czerniecki1, S. J. Hoover1, N. Khakpour1, J. V. Kiluk1, M. C. Lee1 1Moffitt Cancer Center,Breast Oncology,Tampa, FL, USA
Introduction: In women undergoing mastectomy for breast cancer with prior retropectoral implant-based augmentation, implant sparing mastectomy has been reported. In this study, the safety and feasibility of this novel surgical approach was evaluated.
Methods: A retrospective review of all patients undergoing implant sparing mastectomy from 2006 to 2018 for either breast cancer treatment or prevention at a single institution was performed. Data including patient and tumor characteristics, stage, use of systemic therapy and radiation therapy, 90-day complication rates, type of reconstruction, and recurrence of disease was collected.
Results: A total of 74 women were identified with implant sparing mastectomy from 2006 to 2018. Of these, 49 (66.2%) underwent bilateral mastectomy. A total of 66 (89.2%) received mastectomy after diagnosis of invasive breast cancer or ductal carcinoma in situ (DCIS) while 8 (10.8%) elected mastectomy for prophylaxis. Among 66 breast cancer patients, resection margins were negative in 53 (80.3%), negative but close (DCIS < 2mm) in 10 (15.2%), and positive in 3 (4.5%). Five (7.6%) of these breast cancer patients had a documented recurrence; 4 at distant sites, and 1 local recurrence in the chest wall despite adjuvant chemotherapy and radiation therapy in the setting of node positive disease for which axillary lymph node dissection was declined. No new breast cancer diagnoses were reported in the 8 patients that underwent implant sparing mastectomy for prophylaxis alone. Ninety-day complication rates for all patients were low; 1 patient (1.4%) had a seroma requiring aspiration, 1 patient (1.4%) had a wound infection requiring antibiotics, and 4 (5.4%) had a hematoma requiring operative intervention. Three patients (4.1%) had wound dehiscence and 8 (10.8%) had flap loss. Of those patients with flap loss, 6 required debridement in the operating room (OR), and 1 of these patients required OR for free flap loss that was performed immediately after implant sparing mastectomy. The only complication rate higher than expected based on the literature was that of hematoma requiring operative intervention. The vast majority, 64 (86.5%) underwent delayed reconstruction. Of these, only 7 required flap reconstruction, the remainder of patients underwent implant exchange only.
Conclusion: For patients with previous implant-based augmentation pursuing mastectomy for breast cancer treatment or prevention, implant sparing mastectomy is a novel surgical approach with local recurrence and overall complication rates comparable to skin-sparing mastectomy with the exception of a slightly increased hematoma rate. Finally, delayed reconstruction for these patients often requires no more than implant exchange with a low rate of need for flap reconstruction. As such this study suggests that implant sparing mastectomy is a safe and reasonable approach for selected patients.