Abstract:

Objective

To study clinical application and methods of immediate breast reconstruction for subareolar breast carcinomas.

Methods

Fifteen cases with subareolar breast cancer were retrospectively analyzed from Jan 2004 to Dec 2007 at the First Department of Breast Surgery，Cancer Hospital，Tianjin Medical University.Three cases were 0 stage，7 casesⅠstage and 5 casesⅡstage.Among the 15 cases，13 were treated with breast conserving therapy plus immediate breast reconstruction with latissimus dorsi musculocutaneous（LDM）flap using periareolar incision under the condition of negative excision margin of samples by pathologic diagnosis of fast frozen sections；2 cases were treated with mastectomy plus immediate breast reconstruction with LDM flap and implant due to positive excision margin by pathologic examination of frozen sections.Nine cases accepted immediate nipple-areola reconstruction，2 cases accepted delayed nipple reconstruction and 4 cases refused nipple-areola reconstruction.

Results

Of the 13 cases treated with breast conserving therapy plus immediate reconstruction with LDM flap，12 were satisfied with postoperative results，and the satisfactory rate was 92.31%；1 patient was unsatisfied with her reconstructed breast due to central retraction，but it was symmetrical with the healthy breast.Two patients treated with LDM flap and implant reconstruction were satisfied with the results.Of the 9 cases with immediate nipple reconstruction 7 were alive and 2 had partial necrosis.In 3 cases the reconstructed nipple-areola was higher than that of the healthy side，whereas，2 cases with delayed nipple-areola reconstruction were satisfied with their results including the shape and position.Six out of 15 patients were complicated with dorsal subcutaneous edema and 1 case had dorsal incision cracking.The follow-up time varied from 10 months to 48 months，with average of 25 months.One case had recurrence at local incision but no metastasis，with the recurrence rate of 7.69%.

Conclusions

Breast conserving therapy plus immediate breast reconstruction with LDM flap for central breast carcinoma can raise the satisfactory rate of reconstructed breast contour，and immediate reconstruction of nipple-areola can be performed.There is no difference in local recurrence and distant metastasis compared with mastectomy.

Key words: Breast neoplasms, Breast conserving therapy, Latissimus dorsi muscular flap, Breast reconstruction, Nipple areola complex