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Cirugía Plástica Ibero-Latinoamericana

versão On-line ISSN 1989-2055versão impressa ISSN 0376-7892

Resumo

AVELLANEDA OVIEDO, E Mauricio et al. Reductive risk surgery with prosthetic reconstruction by using type IV skin sparrow mastectomy with free nipple-areola graft. Cir. plást. iberolatinoam. [online]. 2019, vol.45, n.2, pp.139-150.  Epub 14-Out-2019. ISSN 1989-2055.  http://dx.doi.org/10.4321/s0376-789220190002000006.

Background and objective

Advances in treatment of breast cancer and different reconstructive options make it necessary to understand a variety of procedures depending on the type of oncological surgery performed on each patient. The range of reconstructive procedures varies from delayed post-mastectomy reconstruction, using skin expanders and in a second time implantation of a definitive prosthesis, to immediate reconstruction by complex microsurgical techniques in a single time.

Our aim is to illustrate, step by step, an immediate breast reconstruction technique in a single time using alloplastic prostheses after a skin-sparing mastectomy in patients that are subsidiary to risk-reducing surgery, formerly called prophylactic mastectomy, is a frequent indication in our setting used for primary and secondary prevention of breast cancer.

Methods

The procedure of a type IV mastectomy with nipple-areola complex free graft (MIVAP) is carefully described. Original drawings and didatic images are shown for the correct understanding of the procedure. We present 9 cases with their different indications.

Results

The most frequent indication in our sample to perform a MIVAP was a history of gynecological cancer (ovary or breast) associated with a mutation in BRCA 1 or 2 gene. Other indications were: positivity for BRCA 1 or 2 mutation without cancer history, mutations in p53 suppressor gene (Li-Fraumeni syndrome), cancer-phobia or high family burden of breast or ovarian cancer (more than 3 first consanguinity line parents) without any mutation.

There was a case of postoperative infection, 1 patient developed grade II postsurgical lymphedema associated with selective sentinel lymph node biopsy (BSGC), and 1 suffered nipple-areola partial necrosis.

The most frequent negatively aesthetic effect was tissue fibrosis with lack of volume in the medial quadrants of the breast (broad image of the neckline). Patients returned to the habitual life around 34 days after the procedure. The prosthesis most frequently used was textured, high projection between 250 and 350 gr.

Conclusions

MIVAP is a valid technique for breast reconstruction in candidates for risk-reducing mastectomy. Although there are certain aesthetic limitations, it is performed in a single surgical time and avoids complications related to cutaneous expanders. Our cases evolved favorably, with a low incidence of complications and a high degree of satisfaction.

Palavras-chave : Mastectomy; Risk reduction mastectomy; breast reconstruction; Breast cancer.

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