Subcutaneous Mastectomy with Direct-to-Implant Breast Reconstruction - Indications and Results

Performing radical mastectomy for breast cancer in cases where organ-sparing operation cannot be done leads almost always to significant psycho-emotional consequences for patients.Aim: The aim of this paper is to present the indications and our initial results from performed subcutaneous mastectomies with direct-to-implant breast reconstructions.Material and Methods: During a two-year period, 26 subcutaneous mastectomies were performed in our clinic on women with mammary carcinoma aged from 28 to 52 years. In all patients, inferolateral approach was used when performing subcutaneous mastectomy. Axillary lymph node dissection was performed in 18 patients, in 6 of them - with prophylactic mastectomy of the opposite breast. Each mastectomy was followed by titanium mesh fixation to the lower end of the large pectoral muscle with implant insertion and positioning of TiLoop® Mesh along the infra-mammary fold and laterally.Result: The follow-up period of patients is 6 to 24 months. Local recurrence was not established for that period. The cosmetic result was described as very good and excellent in 96% of patients. The following complications were observed: postoperative seroma in two cases, wound dehiscence in 1 case, one nipple-areola complex (NAC) necrosis and removal of the implant in 1 case.Conclusions: The NAC sparing subcutaneous mastectomy and one step breast reconstruction with implant is a safe procedure. It combines the radical nature of surgery with improved cosmetic result. All patients reported improved psycho-emotional status.