Plastic Surgery of the Breast - Breast Cancer v15-Course Article Is Oncologic Safety Compatible with a Predictably Viable Mastectomy Skin Flap

Course Article Is Oncologic Safety Compatible with a Predictably Viable Mastectomy Skin Flap

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The study explores the balance between oncologic safety and skin flap viability in skin-sparing mastectomies. Skin-sparing mastectomy is advantageous but prone to flap necrosis due to inadequate thickness. The study aims to provide guidelines for surgeons to preserve the subcutaneous tissue layer while maintaining oncologic principles. Through examination of 76 breast specimens from women receiving reduction mammaplasty, it was found that a distinct non-breast-bearing subcutaneous tissue layer exists between the dermis and breast parenchyma, with a median thickness of about 1 cm. Importantly, this thickness does not correlate with body mass index, age, or breast sample weight. <br /><br />The findings suggest that oncologic safety and flap viability can coexist if the oncologic surgeon preserves the non-breast-bearing subcutaneous layer while elevating skin flaps and excising cancerous tissue. This could maintain flap viability and enhance reconstructive outcomes. The study emphasizes that flap elevation should align with anatomical guidelines to maintain viability and mitigate necrosis risks.<br /><br />Historically, complete breast tissue removal in mastectomies is rare, with residual tissues often found despite conservative approaches. Local cancer recurrence is often associated with mastectomy scars rather than skin flaps. Hence, preserving a viable skin flap with the non-breast-bearing tissue intact seems reasonable. The study concludes that skin flap integrity should not compromise oncologic outcomes, advocating for maintaining the distinct subcutaneous layer to ensure effective, safe mastectomy procedures.<br /><br />The study advises oncologic surgeons to prioritize thicker, uniform mastectomy flaps and utilize the consistent anatomical subcutaneous layer as a guide to enhance breast reconstruction results while ensuring oncologic safety.

Keywords

oncologic safety

skin-sparing mastectomy

flap viability

subcutaneous tissue

breast reconstruction

flap necrosis

oncologic surgeon

anatomical guidelines

cancer recurrence

mastectomy procedures