Two-stage approach to risk-reducing mastectomy improves results for women with large breasts

August 29, 2017, Wolters Kluwer Health

For women undergoing risk-reducing mastectomy to prevent breast cancer, reconstruction can be challenging in those with larger breasts. A two-stage approach—with initial breast reduction and "pre-shaping" followed by mastectomy and reconstruction—appears to be a safer procedure with better cosmetic results, reports the September issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Targeted reduction/pre-shaping "primes" the breast for mastectomy and implant reconstruction performed a few months later, according the study by Gudjon L. Gunnarsson, MD, and colleagues of Telemark Hospital, Skien, Norway.

Breast Pre-Shaping Lowers Risks, Improves Final Results

More women are undergoing mastectomy and breast reconstruction to reduce their risk of familial , based on detection of specific risk genes. Typically this is done in a single-stage procedure, with "nipple-sparing" mastectomy of both breasts followed by immediate breast reconstruction using implants.

However, it can be challenging to achieve good results with immediate reconstruction in women with large breasts (macromastia) with sagging or drooping (ptosis). These patients "more often end up having a difficult corrective procedure and unacceptably high rate of failed reconstruction," Dr. Gunnarsson and coauthors write.

To improve their results, the researchers developed a targeted, two-stage approach to this group of patients. In the first stage, the women underwent a breast reduction/breast lift (mastopexy) procedure to create "a breast better suited for implant reconstruction." In addition to reducing and reshaping the breast, an important part of this procedure was to lift the nipple-areola complex (nipple and surrounding tissues) to a more central position.

After a few months for healing, the women proceeded to the standard risk-reducing mastectomy and implant-based reconstruction. The online version of the article on the Plastic and Reconstructive Surgery website includes a video illustrating key aspects of the technique for plastic surgeons.

Between 2013 and 2015, Dr. Gunnarsson and colleagues used this two-stage approach in 22 women, median age 46 years. Mastectomy and subsequent reconstruction were successfully completed in all 44 breasts. The reconstructions were performed three to nine months (median four months) after initial breast reduction/reshaping.

Two patients had complications requiring repeat surgery; another five patients had minor complications that resolved with nonsurgical treatment. Importantly, there were no problems with the blood supply and survival of the nipple-areola complex.

In all cases, the cosmetic outcomes were rated excellent. The authors believe their technique is an important contribution to improving the results of risk-reducing mastectomy and for women with large breasts. They note that the initial breast reduction/preshaping step "preconditions" the blood supply to the later reconstructed breast.

Dr. Gunnarsson and colleagues add that the two-stage procedure has become their "standard of care" for with large breasts undergoing risk-reducing . The researchers write, "The superior cosmetic outcome and low complication rate have proved to be better than we had anticipated."

Explore further: Some women may benefit from delaying breast reconstruction following mastectomy

More information: Gudjon L. Gunnarsson et al. Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast, Plastic and Reconstructive Surgery (2017). DOI: 10.1097/PRS.0000000000003621

Related Stories

Some women may benefit from delaying breast reconstruction following mastectomy

July 19, 2017
Some patients with a combination of risk factors, such as being obese and having diabetes or being a smoker, may benefit from delayed rather than immediate breast implant reconstruction after a mastectomy to decrease their ...

Plastic surgeons urged to 'embrace the change' to single-stage implant breast reconstruction

July 30, 2015
Some women with breast cancer can now undergo a "one and done" approach combining nipple-sparing mastectomy with immediate single-stage implant (SSI) breast reconstruction in a single procedure, according to a report in the ...

Investigating quality of life after breast reconstruction

April 13, 2017
After a mastectomy, women who underwent autologous breast reconstruction—where the breast is rebuilt using tissue taken from the patient's own body—reported greater psychosocial and sexual well-being than those who chose ...

Nipple-sparing mastectomy has low rate of breast cancer recurrence

July 17, 2017
Women with breast cancer who undergo nipple-sparing mastectomy (NSM) have a low rate of the cancer returning within the first five years, when most recurrences in the breast are diagnosed, findings of a single-center study ...

Older women may not be offered breast reconstruction after mastectomy

February 8, 2017
A national study from England indicates that older women are often not offered immediate breast reconstruction following a mastectomy, even though guidelines state that surgeons should discuss reconstruction with all suitable ...

Fat injection for breast reconstruction doesn't increase risk of recurrent breast cancer

January 29, 2016
For women undergoing breast cancer surgery, a technique called lipofilling—using the patient's own fat cells to optimize the results of breast reconstruction—does not increase the risk of recurrent breast cancer, reports ...

Recommended for you

DNA vaccine leads to immune responses in HPV-related head and neck cancer

September 21, 2018
A therapeutic vaccine can boost antibodies and T cells, helping them infiltrate tumors and fight off human papillomavirus (HPV)-related head and neck cancer. Researchers from the Abramson Cancer Center of the University of ...

In zebrafish, a way to find new cancer therapies, targeting tumor modulators

September 21, 2018
The lab of Leonard Zon, MD, at Boston Children's Hospital has long been interested in making blood stem cells in quantity for therapeutic purposes. Looking for a way to test for their presence in zebrafish, their go-to research ...

What can salad dressing tell us about cancer? Think oil and vinegar

September 20, 2018
Researchers led by St. Jude Children's Research Hospital scientists have identified another way the process that causes oil to form droplets in water may contribute to solid tumors, such as prostate and breast cancer. The ...

Novel biomarker found in ovarian cancer patients can predict response to therapy

September 20, 2018
Despite months of aggressive treatment involving surgery and chemotherapy, about 85 percent of women with high-grade wide-spread ovarian cancer will have a recurrence of their disease. This leads to further treatment, but ...

Testing fluorescent tracers used to help surgeons determine edges of breast cancer tumors

September 20, 2018
A team of researchers with members from institutions in The Netherlands and China has conducted a test of fluorescent tracers meant to aid surgeons performing tumor removal in breast cancer patients. In their paper published ...

Cancer immunotherapy might benefit from previously overlooked immune players

September 20, 2018
Cancer immunotherapy—efforts to boost a patient's own immune system, allowing it to better fight cancer cells on its own—has shown great promise for some previously intractable cancers. Yet immunotherapy doesn't work ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.