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Houvenaeghel G, Cohen M, Dammacco MA, D'Halluin F, Regis C, Gutowski M, Acker O, Fournier M, Bannier M, Lusque A, Jouve E. Prophylactic nipple-sparing mastectomy with immediate breast reconstruction: results of a French prospective trial. Br J Surg 2021; 108:296-301. [PMID: 33793719 DOI: 10.1093/bjs/znaa082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 10/14/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) is used increasingly when performing a prophylactic mastectomy. Few prospective studies have reported on complication rates. This complementary trial to the French prospective multicentre MAPAM trial aimed to evaluate the nipple-areola complex (NAC) necrosis rate in prophylactic NSM with IBR. METHODS Patient characteristics and surgical data were recorded. Morbidity after prophylactic NSM with a focus on NAC necrosis was analysed. RESULTS Among 59 women undergoing prophylactic NSM, 19 (32 per cent) of the incisions were partly on the NAC. Reconstructions were performed with 46 definitive implants and 13 expanders. The crude rate of postoperative complications was 25 per cent (15 patients). Complete NAC necrosis was reported in two women (3 per cent) and partial or total necrosis in nine (15 per cent). No NAC resection was necessary. Median BMI was lower in women with total or partial NAC necrosis compared with the others (20.0 versus 21.3 kg/m2 respectively; P = 0.034). CONCLUSION Results of this prospective study confirm that prophylactic NSM with IBR is associated with a low risk of total NAC necrosis.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgical Oncology, Paoli Calmettes Institute and Centre de Recherche en Cancerérologie de Marseille (CRCM), Aix-Marseille University, Marseille, France
| | - M Cohen
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - M A Dammacco
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - F D'Halluin
- Surgery Department, L'Etablissement Rennais du Sein, Centre Hospitalier Privé St Grégoire, St Grégoire, France
| | - C Regis
- Department of Surgical Oncology, Centre Oscar Lambret, Lille, France
| | - M Gutowski
- Department of Surgical Oncology, Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France
| | - O Acker
- Surgery Department, Pôle Santé Léonard de Vinci, Chambray les Tours, France
| | - M Fournier
- Department of Surgical Oncology, Institut Bergonie, Bordeaux, France
| | - M Bannier
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - A Lusque
- Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - E Jouve
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
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Houvenaeghel G, Cohen M, Ribeiro SR, Barrou J, Heinemann M, Frayret C, Lambaudie E, Bannier M. Robotic Nipple-Sparing Mastectomy and Immediate Breast Reconstruction With Robotic Latissimus Dorsi Flap Harvest: Technique and Results. Surg Innov 2020; 27:481-491. [PMID: 32418492 DOI: 10.1177/1553350620917916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. Only few cases of robotic latissimus dorsi flap reconstruction (RLDFR) have been reported in indication of reconstruction for breast cancer (BC). We report our experience of combined robotic nipple-sparing mastectomy (R-NSM) and RLDFR, and analyze technique, indications, and reproducibility. Methods. All patients with R-NSM and RLDFR from November 2016 to August 2, 2018, were analyzed, and technics have been described. Complication rate with Clavien-Dindo grading and postoperative hospitalization length (days) are reported. Results. Thirty-five R-NSM with RLDFR were performed in 22 cases for primitive BC and 13 for local recurrence. In 12 patients, another surgical procedure was performed during the same time (axillary lymph node dissection or contralateral breast surgery). R-NSM was realized through a short axillar incision, with inside-only installation for 12 patients (34.3%): 18 nonautologous and 17 autologous RLDFR associated with implant in 9 patients. In logistic regression, mastectomy weight >330 g was significantly associated with the use of implant (odds ratio [OR] = 17, P = .015), and significant factor of the time of anesthesia ≥380 minutes was 2 installations (OR = 10.4, P = .049). The median duration of hospitalization stay was 4 days. Complications rates were 51.4% (18/35; 9 grade-1, 2 grade-2, and 7 grade-3). In logistic regression, associated other surgical procedure was predictive of grade-3 complications (OR = 6.87, P = .053). Conclusion. We confirmed the reproducibility and safety of R-NSM and RLDFR with a decreased complication rate. NSM was performed in 42.8% of our patients after previous radiotherapy. We observed an increase of grade-3 complications when R-NSM and RLDFR was combined to another surgical procedure.
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Affiliation(s)
- Gilles Houvenaeghel
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Monique Cohen
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Sandrine Rua Ribeiro
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Julien Barrou
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Mellie Heinemann
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Christine Frayret
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Eric Lambaudie
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Marie Bannier
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
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Oncologic outcomes and radiation safety of nipple-sparing mastectomy with intraoperative radiotherapy for breast cancer. Breast Cancer 2019; 26:618-627. [PMID: 30888580 DOI: 10.1007/s12282-019-00962-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy combined with breast reconstruction helps to optimize the contour of the breast after mastectomy. However, the indications for nipple-sparing mastectomy are still controversial. Local radiation to the nipple-areola complex may play some roles in improving the oncological safety of this procedure. METHODS From January 2014 to December 2017, 41 consecutive patients who underwent nipple-sparing mastectomy combined with Intrabeam intraoperative radiotherapy to the nipple-areola complex flap and breast reconstruction were enrolled in this prospective study. The prescribed radiation dose at the surface of the spherical applicator was 16 Gy. RESULTS In eight cases, carcinomas were in the central portion of the breast. Partial necrosis of the nipple-areola complex occurred in three cases. Over 90% of patients reported "no or poor sensation" of the nipple-areola complex postoperatively. With a median follow-up time of 26 months, no recurrences or metastases were identified; however, breast-cancer mortality occurred in one patient. Pathologic evaluation of paraffin-embedded sections showed ductal carcinoma in situ in the remaining tissues deep to the nipple-areola complex flap in two patients. Although no further treatment was administered to the nipple-areola complexes postoperatively, no recurrences or metastases were identified 20 months and 24 months later, respectively. Optical microscopy and transmission electron microscopy revealed changes in some normal tissues immediately after Intrabeam intraoperative radiotherapy. Karyopyknosis were observed in gland tissues, and the collagenous fibers became sparse and arranged chaotically. As assessed by thermoluminescence, radiation doses at different sites in the nipple-areola complex flap varied considerably and were about 10 Gy at the areola surface. No Intrabeam intraoperative radiotherapy-related acute or chronic radiation injuries of the lung, heart or bone marrow were identified. CONCLUSIONS Our findings indicate that Intrabeam intraoperative radiotherapy during nipple-sparing mastectomy combined with breast reconstruction is safe and feasible. TRIAL REGISTRATION The current study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou Medical University (registering order 201750). All participants gave their written informed consent.
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Houvenaeghel G, Bannier M, Rua S, Barrou J, Heinemann M, Van Troy A, Lambaudie E, Cohen M. Breast cancer robotic nipple sparing mastectomy: evaluation of several surgical procedures and learning curve. World J Surg Oncol 2019; 17:27. [PMID: 30728011 PMCID: PMC6366058 DOI: 10.1186/s12957-019-1567-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies of robotic nipple sparing mastectomy (NSM) were reported. We report feasibility of robotic NSM and determine standard surgical procedure and learning curve threefold. METHODS A cohort of patients with robotic NSM for breast cancer was analyzed. Complications and post-operative hospitalization stay were reported. The same technic was used for all patients except for skin and nipple areolar complex (NAC) dissection. Differences between three surgical procedures of NAC dissection were analyzed: group 1, dissection with robotic scissors using coagulation; group 2, dissection with robotic scissors without coagulation; and group 3, dissection with non-robotic scissors and then robotic dissection. We explored possible effect of learning curve among patients from group 1 with the same surgical procedure. RESULTS Twenty-seven NSM with immediate breast reconstruction for breast cancers, 22 invasive and 5 in situ, were performed, with robotic latissimus dorsi-flap (RLDF) only in 17 cases, RLDF and breast implant in 6 cases, and implant alone in 4 cases. Repartition according to 3 surgical procedure groups was 16, 5, and 6 patients. Mean time of surgery and anesthesia decrease according to groups 1 to 3. Among 16 patients from group 1, time of surgery and anesthesia decreased with learning curve. Post-operative hospitalization decreased from group 1 to 3. We reported a total of 11 complications, with significant difference between groups (10 for group 1). Skin complications were higher for group 1 in comparison with groups 2-3 (p = 0.02). CONCLUSION Robotic NSM can be performed with a brief learning. Standardized technique is proposed with non-robotic scissors superficial dissection and then dissection with robot.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France.
| | - M Bannier
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - S Rua
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - J Barrou
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - M Heinemann
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - A Van Troy
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - E Lambaudie
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - M Cohen
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
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