ISSN : 2146-3123
E-ISSN : 2146-3131

Favorable Outcome with Close Margins in Patients Undergoing Nipple/Skin Sparing Mastectomy with Immediate Breast Reconstruction: 5-year Follow-up
Enver Özkurt 1, Mustafa Tükenmez 1, Erdem Güven 2, Burcu Çelet Özden 2, Gizem Öner 1, Mahmut Müslümanoğlu 1, Abdullah İğci 1, Vahit Özmen 1, Seden Küçücük 3, Neslihan Cabioğlu1
1Department of General Surgery, Breast Unit, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
2Department of Plastic Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
3Department of Radiation Oncology, İstanbul University İstanbul Institute of Oncology, İstanbul, Turkey
DOI : 10.4274/balkanmedj.2017.0029

Background: Implant-based breast reconstruction after mastectomy has recently been reported to be the preferred type of surgery among breast specific surgeons and plastic surgeons. 
Aims: The aim of this study is to explore the significant clinicopathological factors associated with long term outcome related to local recurrences of the nipple among patients who underwent immediate breast reconstruction (IBR) with tissue expander (TE) or implant after mastectomy. 
Study Design: Retrospective cohort 
Methods: From January 2007 to January 2013, 51 breast cancer patients who underwent IBR with TE or implant were retrospectively analyzed. Patient’s demographic data, clinicopathological characteristics, and clinical outcome by disease free survival (DFS) and disease specific survival (DSS) analyses were determined. 
Results: The median follow-up was 64 (31-114) months. Of the 57 mastectomies, 41 were skin sparing (SSM) (72%) and 16 were nipple-areola sparing (NSM) (28%). IBR surgery included TE (n=46, 81%) or implant (n=11, 19%) placement. The molecular subgroups of 47 invasive cancers were as follows: luminal A (n=23, 49%), luminal B (n=16, 34%), non-luminal HER2 (n=5, 10.6), triple negative breast cancer (n=3, 6.4%). The 5-years DSS, DFS, and loco-regional recurrence free survival rates were 96.8%, 90%, and 97.6% respectively. Patients with luminal A cancer were found to have an improved 5- year DFS time than other (luminal A; 100% vs. non-luminal A; 78%; p=0.028). Of the 14 NSM, 13 had a close median tumor distance to nipple-areola complex (NAC) (<20mm) with a 5-year loco-regional recurrence free survival of 100%. 
Conclusions: IBR with implant or TE can be safely applied in patients undergoing SSM or NSM. Patients with luminal-A type show the most favorable outcome. During the 5-year follow-up period patients even with close margins (<20mm) to NAC with NSM have excellent locoregional and overall survival when treated by contemporary multidisciplinary oncological management.

Keywords : Breast Implants, Nipple Sparing Mastectomy, Immediate Breast Reconstruction, Disease-Free Survival, Local Recurrence
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