Can Skin Sparing Mastectomy and Immediate Submuscular Implant-Based Reconstruction Be a Better Choice in Treatment of Early-Stage Breast Cancer?

Objective: To discuss if skin sparing mastectomy (SSM) with immediate submuscular implant-based reconstruction (IBR) can be the preferred treatment in early-stage breast cancer. Materials and Methods: Patients treated for clinical in situ or early-stage invasive breast cancer with SSM and immediate submuscular IBR between October 2016 and October 2018 were retrospectively evaluated. Results: Twenty-one cases were reviewed, of whom18 had two-stage and three had one-stage IBR. Median (range) follow-up period was 42 (32-61) months. Five underwent axillary dissection and 1-2 metastatic nodes were found in three (60%). Eight patients (38.09%) with two-stage IBR had radiotherapy because of upstaging and three (37.5%) experienced radiotherapy-linked complications. Rate of complications and mean number of events recorded per patient were higher with radiotherapy. Four patients (44%) had unwanted events after secondary surgery. The mean number of surgeries was higher after two-stage IBR. Mean duration increased in those with chemo-radiotherapy. Six with two-stage and two with one-stage IBR discontinued secondary surgeries. Conclusion: SSM with immediate submuscular IBR is not suitable in all patients with early-breast cancer. It takes long to have aesthetically pleasing, symmetrical breasts after primary operation because of additional corrective/matching surgeries. Radiotherapy may still be required because of upstaging. Expectation and tolerability of the patient to the process should be evaluated as well as tumor biology and the status of the axilla.