A Preliminary Experience of Endoscopic Total Mastectomy With Immediate Free Abdominal-Based Perforator Flap Reconstruction Using Minimal Incisions, and Literature Review

Sabrina Ngaserin; Allen Wei-Jiat Wong; Faith Qi-Hui Leong; Jia-Jun Feng; Yee Onn Kok; Benita Kiat-Tee Tan

doi:10.4048/jbc.2023.26.e10

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저자정보: Sabrina Ngaserin (Breast Service Department of Surgery Sengkang General Hospital Singapore.SingHealth Duke-NUS Breast Centre Singapore.) Allen Wei-Jiat Wong (Plastic Reconstructive & Aesthetic Surgery Service Department of Surgery Sengkang General Hospital Singapore) Faith Qi-Hui Leong (Breast Service Department of Surgery Sengkang General Hospital Singapore.SingHealth Duke-NUS Breast Centre Singapore.) Jia-Jun Feng (Plastic Reconstructive & Aesthetic Surgery Service Department of Surgery Sengkang General Hospital Singapore) Yee Onn Kok (Plastic Reconstructive & Aesthetic Surgery Service Department of Surgery Sengkang General Hospital Singapore) Benita Kiat-Tee Tan (Breast Service Department of Surgery Sengkang General Hospital Singapore.SingHealth Duke-NUS Breast Centre Singapore.)

저널정보: 한국유방암학회 Journal of Breast Cancer Journal of Breast Cancer Vol.26 No.2

발행연도: 2023.4

수록면: 152 - 167 (16page)

DOI: 10.4048/jbc.2023.26.e10

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Purpose: Endoscopic total mastectomy (ETM) is predominantly performed with reconstruction using prostheses, lipofilling, omental flaps, latissimus dorsi flaps, or a combination of these techniques. Common approaches include minimal incisions, e.g., periareolar, inframammary, axillary, or mid-axillary line, which limit the technical ability to perform autologous flap insets and microvascular anastomoses, as such the ETM with free abdominal-based perforator flap reconstruction has not been robustly explored. Methods: We studied female patients with breast cancer who underwent ETM and abdominal-based flap reconstruction. Clinical-radiological-pathological characteristics, surgery, complications, recurrence rates, and aesthetic outcomes were reviewed. Results: Twelve patients underwent ETM with abdominal-based flap reconstruction. The mean age was 53.4 years (range 36–65). Of the patients, 33.3% were surgically treated for stage I, 58.4% for stage II, and 8.3% for stage III cancer. Mean tumor size was 35.4 mm (range 1–67). Mean specimen weight was 458.75 g (range 242–800). Of the patients, 92.3% successfully received endoscopic nipple-sparing mastectomy and 7.7% underwent intraoperative conversion to skin-sparing mastectomy after carcinoma was reported on frozen section of the nipple base. Mean operative time for ETM was 139 minutes (92–198), and the average ischemic time was 37.3 minutes (range 22–50). Fifty percent of patients underwent deep inferior epigastric perforator, 33.4% underwent MS-2 transverse rectus abdominis musculocutaneous (TRAM), 8.3% underwent MS-1 TRAM, and 8.3% underwent pedicled TRAM flap reconstruction. No cases required re-exploration, no flap failure occurred, margins were clear, and no skin or nipple-areolar complex ischemia/necrosis developed. In the aesthetic outcome evaluation, 16.7% were excellent, 75% good, 8.3% fair, and none were unsatisfactory. No recurrences were observed. Conclusion: ETM through a minimal-access inferior mammary or mid-axillary line approach, followed by immediate pedicled TRAM or free abdominal-based perforator flap reconstruction, can be a safe means of achieving an “aesthetically scarless” mastectomy and reconstruction through minimal incisions.

#Breast Neoplasms #Free Tissue Flap #Mastectomy #Subcutaneous #Perforator Flap

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Sabrina Ngaserin

소속기관 Breast Service Department of Surgery Sengkang General Hospital Singapore.SingHealth Duke-NUS Breast Centre Singapore.