Skin-reducing mastectomy and implant reconstruction: Long-term surgical, oncological, and patient-reported outcomes

Abstract

BACKGROUND: Skin-reducing mastectomy (SRM) allows implant-based immediate breast reconstruction in women with large, ptotic breasts. This study aimed to evaluate the surgical and patient-reported outcomes (PRO) following SRM. METHODS: A retrospective analysis was conducted on patients who underwent SRM between January 2011 and December 2014. Surgical complications, oncological outcomes, and PRO (using BREAST-Q) were collected, with a median follow-up of 10 years. RESULTS: Fifty-five women (95 breasts) underwent SRM and completed the first round of the BREAST-Q questionnaire. 82.3% (n = 45) had SRM for cancer treatment, and the remaining had risk-reducing surgery. 83.6% (n = 46) had direct-to-implant reconstruction, and the remainder had a tissue expander inserted. The mean breast weight was 714 g, and the mean implant volume was 398 mL. The overall complication rate was 58.9%. The most common complication was skin loss due to flap/skin necrosis (24.2%), followed by capsular contracture (18.9%), seroma (7.4%), wound dehiscence (5.3%), implant infection (2.1%), and bleeding (1%). The early implant loss rate was 10.5%. At 10 years (n = 17), the local recurrence rate was 4.4%, the overall survival rate was 97.7%, and the disease-free survival rate was 88.9%. Breast-Q scores were comparable to previous studies (mean score of 65.33). 30.9% of patients (n = 17) completed the modified BREAST-Q questionnaire at 10 years of follow-up. Reconstructed breast satisfaction was high, and 76.5% of patients would choose to undergo SRM again if given the option. CONCLUSIONS: In certain patients with larger breasts, SRM can facilitate implant-based immediate breast reconstruction without the need for mesh. Despite relatively high complication rates, patient satisfaction remains high.