Clinical assessment of skin incisions used for skin-sparing mastectomy

Abstract

Background:  Skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) has become a popular and effective therapy for patients with early breast cancer. We review the types of incisions used for SSM.

Methods:  We retrospectively reviewed records of 173 consecutive patients with breast cancer, who underwent SSM with IBR between 1 July 2003 and 30 June 2016 at our hospital. Incisions used in those procedures included the so-called tennis racket incision, consisting of a periareolar incision with lateral extension (Type A [A]);, a periareolar incision with mid-axillary incision (Type B [B]);, the so-called areola-sparing incision in either, medio-lateral (Type C1 [C1]) or cranio-caudal (Type C2 [C2]) direction with mid-axillary incision;, and a small transverse elliptical incision with transverse axillary incision (Type D [D]).    Results:  Type A incisions were used for SSM in 26 patients, Type B in 91, either Type C1 or C2 in 91, and D in 15. The average areolar diameter was 34 mm with Type A, 37 mm with B, 40 mm with both C types (C1, 45 mm; C2, 33 mm), and 32 mm with D. Seventy-seven percent of patients desired postoperative nipple-areolar complex plasty (NAC-p) with Type A, 78% with B, 46% with C, and 80% with D. In our hospital, use has increased of Types B and C1 since 2007 and of Types C2 and D for device-based breast reconstruction since 2011.

Conclusions:  Incisions of Type C provide superior cost and cosmetic outcomes, with fewer patients requesting NAC-p, and C2 is considered most suitable when patients desire device-based breast reconstruction.