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Open Access Highly Accessed Research

Skin-sparing mastectomy and immediate latissimus dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes

Zisun Kim1, Sang Gue Kang2, Jung Ho Roh1, Ji Hye Park1, Jihyoun Lee1, SungYong Kim1, Cheol Wan Lim1 and Min Hyuk Lee1*

Author Affiliations

1 Department of Surgery, Soonchunhyang University Hospital, Hannam-dong, Yongsan-gu, Seoul, 140-743, Korea

2 Plastic and Reconstructive Surgery, Soonchunhyang University Hospital, Hannam-dong, Yongsan-gu, Seoul, 140-743, Korea

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World Journal of Surgical Oncology 2012, 10:259  doi:10.1186/1477-7819-10-259

Published: 29 November 2012

Abstract

Background

Skin-sparing mastectomy (SSM) and latissimus dorsi (LD) flap immediate breast reconstruction (IBR) is a tailored surgical procedure. The surgical and patient-reported outcome (PRO) of SSM and LD IBR were assessed.

Methods

Retrospective data of 146 SSMs performed by a single surgeon was reviewed. Among patients included in the data, 65 patients underwent SSM and LD IBR without a prosthetic implant. A survey estimating the degree of patient satisfaction (poor, fair, good, and excellent) as regards the cosmetic outcomes of surgery was performed. The patients were divided into two groups according to their degree of satisfaction (excellent group versus non- excellent group), and analysis was done to identify factors affecting the highest patient satisfaction.

Results

The mean age of the patients was 48.4 years, and pathological results were: infiltrating ductal carcinoma (n = 48, 73.8%), ductal carcinoma in situ (n = 15, 23.1%), and others (n = 2, 3.1%). One patient received postmastectomy radiotherapy. After a mean follow-up of 34 months, no local recurrence occurred. There was no skin necrosis or LD flap loss. Donor site morbidities were seroma (n = 8, 12.3%), scarring (n = 8, 12.3%), and back pain (n = 6, 9.2%). Fifty patients (76.9%) were satisfied and 40% reported their degree of satisfaction as excellent. Breast symmetry (P <0.001), nipple cosmesis (P <0.001), visual difference of bilateral breasts (P = 0.021), and panel assessment score (P <0.001) were factors that affected the highest patient satisfaction.

Conclusions

Our SSM and LD IBR was safe, with no local recurrence and low morbidities, and produced a sufficiently high level of patient satisfaction. Achieving breast symmetry and nipple cosmesis would be the key to meeting the patient’s expectation.

Keywords:
Breast cancer; Breast neoplasm; Mastectomy; Latissimus dorsi flap; Breast reconstruction; Patient satisfaction