Feasibility of Skin-Reducing Mastectomy and Immediate Reconstruction in Breast Cancer Patients with Large Breast Volume

Document Type : Original Article

Authors

Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt.

10.21608/ejsur.2025.346590.1321

Abstract

Background: Skin-reducing mastectomy (SRM) enables immediate breast reconstruction using a silicone implant or
Lattissimus Dorsi muscle flap (LDF) after mastectomy in large-breasted women with breast cancer. Additionally, it
reduces the occurrence of implant extrusion through providing adequate implant coverage by LDF muscle and/or a deepithelialized dermal flap, with a good inframammary contour.
Aim: The study aims to assess the aesthetic, surgical, and oncological outcome of SRM with immediate reconstruction.
Patients and Methods: A total of 25 patients with large breast size (cup C and D) who are unfit for conservative breast
surgery were included in a prospective feasibility study. Nine (36%) patients had Silicon implant reconstruction, while
sixteen (64%) patients had LDF reconstruction. Eight patients had SRM and reconstruction with immediate contralateral
symmetrization. Seventeen patients underwent total breast reconstruction using LDF or silicone implant after unilateral
SRM without contralateral symmetrization.
Results: As regards complications, five patients had a breast wound gap. Patients with a higher pathological stage had a
higher adverse event rate. There was no significant difference between the incidence of complications and symmetrization, ptosis, or operative characteristics of the studied cases. 17 patients were selected to undergo immediate reconstruction without contralateral breast symmetrization. There was a significant difference between symmetrization surgery and intraoperative blood loss.
Conclusion: Skin-reducing mastectomy with immediate reconstruction using autologous flap as LDF or Silicon implant
is a safe, feasible technique with acceptable surgical, oncological, and aesthetic outcomes. Patient selection is an essential
factor in decreasing the rate of complications.

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