Endoscopic Delayed Breast Reconstruction With Expanders and Implants via the Axillary Incision Made for Sentinel Lymph Node Biopsy or Lymphadenectomy

Background Classic techniques of delayed prosthetic breast reconstruction use the mastectomy scar as an access route. As a result, the filling of the expander must be postponed until the wounds have healed. This creates an asymmetry between the breasts with the volume changes caused by the filling of the expander, which may occur over several weeks and cause considerable discomfort. Methods Delayed breast reconstruction was performed via the axillary incision made for sentinel lymph node biopsy or lymphadenectomy with endoscopic assistance and detachment of the pectoralis major muscle. The filling of the expander and symmetrization with the contralateral breast was performed in the first stage. The expander was replaced with the definitive prosthesis 3 months later, after endoscopic capsulotomy. Fat grafting was performed to create a lipobed around the implant and to improve tissue quality. Results Sixty-two patients underwent surgery. Mean follow-up was 19 months. There were no major complications in the reconstructed breast. One case of hematoma in a contralateral breast reduction and an oil cystic mass secondary to fat grafting were recorded. In all cases, the filling of the expander with the definitive volume was possible during the first stage. Conclusions Endoscopic delayed breast reconstruction with insertion of implants through the axillary incision for sentinel node biopsy or lymphadenectomy is safe and feasible. It achieves complete intraoperative expansion, symmetry between the volumes of the breasts during the first stage, and avoids problems with the scar and the risk of extrusion, as the scar is placed remotely in the axilla.

[1]  Á. Atallah,et al.  Nipple- and areola-sparing mastectomy for the treatment of breast cancer. , 2016, The Cochrane database of systematic reviews.

[2]  S. Kronowitz State of the Art and Science in Postmastectomy Breast Reconstruction , 2015, Plastic and reconstructive surgery.

[3]  P. Cordeiro,et al.  Diminishing relative contraindications for immediate breast reconstruction: a multicenter study. , 2014, Journal of the American College of Surgeons.

[4]  Young Seok Kim,et al.  Immediate Partial Breast Reconstruction with Endoscopic Latissimus Dorsi Muscle Flap Harvest , 2014, Archives of plastic surgery.

[5]  T. Rodrigues,et al.  Immediate Single-stage Endoscopic Latissimus Dorsi Breast and Nipple Reconstruction , 2014, Plastic and reconstructive surgery. Global open.

[6]  V. Ozmen,et al.  Videoendoscopic single-port nipple-sparing mastectomy and immediate reconstruction. , 2014, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[7]  J. Serra-Mestre,et al.  Endoscopic Reconstruction of Partial Mastectomy Defects Using Latissimus Dorsi Muscle Flap Without Causing Scars on the Back , 2013, Aesthetic Plastic Surgery.

[8]  P. Cordeiro,et al.  A Paradigm Shift in U.S. Breast Reconstruction: Increasing Implant Rates , 2013, Plastic and reconstructive surgery.

[9]  J. Selber,et al.  Robotic Latissimus Dorsi Muscle Harvest: A Case Series , 2012, Plastic and reconstructive surgery.

[10]  M. Salgarello,et al.  Fat Grafting and Breast Reconstruction with Implant: Another Option for Irradiated Breast Cancer Patients , 2012, Plastic and reconstructive surgery.

[11]  M. Atzeni,et al.  Cagliari University Hospital (CUH) protocol for immediate alloplastic breast reconstruction and unplanned radiotherapy. A preliminary report. , 2011, European review for medical and pharmacological sciences.

[12]  J. Serra-Renom,et al.  Breast Reconstruction With Fat Grafting Alone , 2011, Annals of plastic surgery.

[13]  S. Paepke,et al.  Extended Indications for Nipple‐Sparing Mastectomy , 2011, The breast journal.

[14]  J. Serra-Renom,et al.  Fat Grafting in Postmastectomy Breast Reconstruction with Expanders and Prostheses in Patients Who Have Received Radiotherapy: Formation of New Subcutaneous Tissue , 2010, Plastic and reconstructive surgery.

[15]  M. Tozaki,et al.  Early Results of an Endoscopic Nipple-Sparing Mastectomy for Breast Cancer , 2009, Annals of Surgical Oncology.

[16]  V. Sacchini,et al.  Nipple-sparing mastectomy: where are we now? , 2008, Surgical oncology.

[17]  J. Amano,et al.  ENDOSCOPIC‐ASSISTED SKIN‐SPARING MASTECTOMY COMBINED WITH SENTINEL NODE BIOPSY , 2008, ANZ journal of surgery.

[18]  M. Missana,et al.  Endoscopic latissimus dorsi flap harvesting. , 2007, American journal of surgery.

[19]  J. Benito-Ruiz,et al.  Endoscopic Breast Reconstruction With Intraoperative Complete Tissue Expansion and Partial Detachment of the Pectoralis Muscle , 2007, Annals of plastic surgery.

[20]  H. Nomura,et al.  Laparoscopically harvested omental flap for immediate breast reconstruction. , 2006, American journal of surgery.

[21]  S. Natsugoe,et al.  Endoscopic quadrantectomy for breast cancer with sentinel lymph node navigation via a small axillary incision. , 2005, Breast.

[22]  Timothy G. Schaefer,et al.  Immediate Endoscopic Latissimus Dorsi Flap: Risk or Benefit in Reconstructing Partial Mastectomy Defects , 2004, Annals of plastic surgery.

[23]  P. Lasser,et al.  Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. , 2003, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[24]  A. Chan,et al.  Endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer , 2002, Surgical Endoscopy And Other Interventional Techniques.

[25]  M. Hashizume,et al.  Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer. , 2002, Surgery.

[26]  I. Cothier-Savey,et al.  Immediate Breast Reconstruction Using a Laparoscopically Harvested Omental Flap , 2001, Plastic and reconstructive surgery.

[27]  J. Serra Retractor with mobile endoscope. , 1997, Plastic and reconstructive surgery.

[28]  R. Blamey,et al.  Subcutaneous mastectomy for primary operable breast cancer , 1984, The British journal of surgery.