Modified radical mastectomy with extended latissmus dorsi flap versus skin sparing mastectomy with sub pectoral silicone implant; a prospective evaluation

Abstract

Modified radical mastectomy with extended latissmus dorsi flap versus skin sparing mastectomy with sub pectoral silicone implant; a prospective evaluation Rania ELahmady MD, Ahmed Gamal Eldin MD, M.A.Marzouk MD Abstract Background: Several types of mastectomy procedures are now available to the breast surgeon. The most commonly performed is total mastectomy, with the removal of the nipple-areola complex (NAC) and the whole breast tissue in addition to the nipple-areola complex skin ellipse. A skin sparing total mastectomy resects all the breast tissue through a circumareolar incision including the resection of the nipple but preserving the skin envelope, thus facilitating immediate reconstruction .Aim of the work: the aim of our work was to compare modified radical mastectomy with extended latissmus dorsi flap with skin sparing mastectomy with sub pectoral silicone implants as regard surgical outcome, patient satisfaction and oncological safety. Patients and methods: This prospective randomized comparative study included 30 patients with invasive breast cancer.15 of them were treated by modified radical mastectomy with extended latissmus dorsi flap (group A) and the other 15 patients were treated by skin sparing mastectomy with sub pectoral silicone implants (group B). The patients were followed up every 3 months for post-operative early and late complications and cosmetic outcome. Result: The mean age for our study was 45.60±5.81. The mean operation time in group A was 3.81±0.76 while in group B was 1.55±0.44with P value 0.0001(HS). Postoperative complications occurred in only 10 cases in the form of 4 cases (13.3%) of wound infection and 6 cases (20%) of haematoma. 5 patients from the 6 patients who had haematoma were in group A.The mean of cosmetic outcome score in group A was 1.60±0.74which fall between poor and good and in group B 4.00 ± 0.93 which fall between good and excellent with P value .001(HS). Conclusion: Skin sparing mastectomy with immediate reconstruction is an excellent choice for cases not suitable for conservative wide local excision provided that there is a good patients’ selection. Key words: latissmus dorsi flap, silicone implant, skin sparing mastectomy.