Prepectoral Breast Reconstruction in Nipple-Sparing Mastectomy - Evolution of Breast Cancer Surgery
Clinical Case Breast cancer is the most common cancer in women worldwide. Although breast cancer surgery is becoming more conservative over the decades, mastectomy still plays a role in breast cancer treatment. Currently, more conservative mastectomy techniques, such as skin or nipple-sparing mastectomies (NSM), are part of the treatment of breast cancer as long as there are no contraindications and oncological safety criteria are guaranteed. These types of mastectomies are technically more challenging and imply increased care such as the correct dissection of the mastectomy anatomic plane and the careful preservation of skin flap vascularization. Immediate breast reconstruction (IBR) following nipple-sparing mastectomy optimizes cosmetics and is associated with improvement of quality of life of breast cancer patients. Traditional subpectoral or muscle reconstructions techniques are usually more complex, associated with postoperative pain and longer recovery period. Advances in surgery technique and biologic or synthetic products over the last decade have enabled surgeons to replace these traditional techniques with a prepectoral or muscle-sparing technique. Prepectoral breast reconstruction is becoming popular among surgeons and patients due to the preservation of normal chest wall anatomy, with the restoration of body image with minimal morbidity and good aesthetic results. In this open classroom, we report the case of a 41-year-old female who presented with a multicentric triple negative breast cancer. After discussion in the multidisciplinary team of our Breast Center, the patient was proposed initially for neoadjuvant chemotherapy and then surgery with nipple sparing mastectomy, sentinel node biopsy, immediate prepectoral reconstruction and contralateral breast reduction in order to have a better symmetry. Neither intra nor postoperative complication occurred and the patient was discharged on the second postoperative day. Final pathology revealed a pathological complete response and, after multidisciplinary discussion, the patient was proposed no adjuvant treatment. The patient is currently under surveillance, with good aesthetic results and with no evidence of cancer recurrence. In conclusion prepectoral breast reconstruction after NSM is a promising and feasible technique that does not compromise oncological treatment and allows a good aesthetic result when performed by specialized teams.
