Surgical management for local recurrence after subcutaneous mastectomy with one-stage immediate reconstruction


  • I.M. Motuziuk Bogomolets National Medical University, Kyiv, Ukraine,
  • O.I. Sydorchuk Bogomolets National Medical University, Kyiv, Ukraine,
  • P.L. Poniatovskyi Bogomolets National Medical University, Kyiv, Ukraine,
  • H.L. Slavuta Bogomolets National Medical University, Kyiv, Ukraine,



local recurrence, breast cancer, reconstructive surgery


Background. Breast reconstruction after mastectomy is an important factor affecting patient’s quality of life. Mechanical and biological features of acellular dermal matrix (ADM) allows simplifying the breast reconstruction and achieving better functional and aesthetic results, especially for women with medium and large breast size. Objective: to present the first experience of breast reconstruction with ADM in Ukraine with the analysis of the technical aspects of surgeries, early and delayed surgical, oncological and functional results. Materials and methods. This work is the retrospective analysis of implant-based breast reconstruction with ADM in the Breast Unit of LISOD Hospital of Israeli Oncology. Results. Thirty-five operations were performed for 27 patients, 34 of them were immediate and one — delayed reconstruction. The average age of women was 44 (30–71) years. Therapeutic procedures were performed in 25 (73.5 %) cases, prophylactic — in 4 (11.8 %), symmetrised — in 5 (14.7 %). Eighteen (52.9 %) mastectomies were nipple-sparing. The average time of follow-up was 46 (6–84) months. Early complications such as ischemia and skin necrosis, infection, hematoma were detected in 11 (31.4 %) cases. Late complications such as infections and late seromas were observed in 4 (11.4 %) cases. Five (14.3 %) revisions were performed, 3 (8.6 %) implants were lost. Grade 3 capsular contracture was found in 5 (14.3 %) reconstructed breasts. Systemic recurrence occurred in 6 patients, 5 of them died. We had performed a survey about aesthetic and functional results in 21 (77.8 %) patients: 19 (90.5 %) were very satisfied and 2 (9.5 %) — were rather satisfied. No patients were unsatisfied. Conclusions. Despite the certain complications rate, the mechanical and biological features of ADM allow us to make an effective breast reconstruction even in patients with medium and large breasts. It provides for the further lipografting, and promotes good aesthetic and functional results after breast reconstruction.


Kris M.G., Benowitz S.I., Adams S., Kris M.G. et al. Clinical cancer advances 2010: annual report on progress against cancer from the American Society of Clinical Oncology [Journal]. J. Clin. Oncol. 2010. Vol. 28. Р. 5327-5347.

Leanna J. Standish, Erin S. Sweet, Jeffrey Novack, Cynthia A. Wenner, Carly Bridge et al. Breast Cancer and the Immune System. J. Soc. Integr. Oncol. 2008 Fall. 6(4). Р. 158-168.

Clarke M., Collins R., Darby S. et al. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials [Journal]. Lancet. 2005. Vol. 366. Р. 2087-2106.

González E.G., Rancati А.О. Skin-sparing mastectomy. Gland Surg. 2015. Vol. 4(6). P. 541-553.

Meretoja T.J., Rasia S., Von Smitten K.A.J., Asko-Seljavaara S.L. Late results of skin-sparing mastectomy followed by immediate breast reconstruction. British Journal of Surgery. 2007. Vol. 94(10). P. 1220-1225.

Malygin S.E., Malygin E.N., Peterson S.B., Protasov A.V., Benevsky A.I. Local and Regional Recurrences after Mastectomy with Immediate Reconstruction in Breast Cancer Patients. Bulletin of RSMU. 2013. 4. Р. 24-27.

Merino T., Ip T., Domínguez F., Acevedo F., Medina L., Villaroe A. et al. Risk factors for locoregional recurrence in breast cancer patients: a retrospective study. Oncotarget. 2018, Jul 13. 9(54). Р. 30355-30362. DOI: 10.18632/oncotarget.25735.

Missana M.C., Laurent I., Germain M., Lucas S., Barreau L. Long-term oncological results after 400 skin-sparing mastectomies. J. Visc. Surg. 2013 Nov. 150(5). Р. 313-320. DOI: 10.1016/j.jviscsurg.2013.09.011.

Yi M., Kronowitz S.J., Meric-Bernstam F., Feig B.W., Symmans W.F., Lucci A. et al. Local, regional, and systemic recurrence rates in patients undergoing skin-sparing mastectomy compared with conventional mastectomy. Cancer. 2011, Mar 1. 117(5). Р. 916-924. DOI: 10.1002/cncr.25505.

Pak D.D., Rasskazova T.A. Recurrent breast cancer after organ-preserving treatment. Oncosurgery. 2012. 4(2). Р. 37-49.

Zikiryakhodzhaev A.D., Rasskazova E.A. Recurrence of breast cancer after subcutaneous mastectomy with simultaneous reconstruction. Research’n Practical Medicine Journal. 2014. 1(1). Р. 24-28.

Fodor J., Major Т., Polgar C. et al. Prognosis of patients with local recurrence after mastectomy or conservative surgery for early-stage invasive breast cancer. Breast. 2008 Jun. 17(3). Р. 302-308.

Fodor J. Breast-conservation treatment for early invasive breast cancer: prognostic factors for survival after salvage treatment of local recurrence. Magy Oncol. 2007. 51(2). Р. 127-131.

Lowery A.J., Kell M.R., Glynn R.W. et al. Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res. Treat. 2012. 133. Р. 831-841.

Zumsteg Z.S., Morrow M., Arnold B. et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer. Ann. Surg. Oncol. 2013. 20. Р. 3469-3476.

Dent R., Trudeau M., Pritchard K.I. et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin. Cancer Res. 2007. 13. Р. 4429-4434. Doi: 10.1158/1078-0432.CCR-06-3045.





Practicing Physician