Nipple sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct-to implant reconstruction

Marta Allué Cabañuz; Maria Dolores Arribas Del Amo; Ismael Gil Romea; María Pilar Val-Carreres Rivera; Ramón Sousa Domínguez; Antonio Tomás Güemes Sánchez

doi:10.1016/j.ciresp.2020.04.028

Nipple sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct-to implant reconstruction

Cir Esp (Engl Ed). 2021 Mar;99(3):215-221. doi: 10.1016/j.ciresp.2020.04.028. Epub 2020 Jun 2.

[Article in English, Spanish]

Authors

Marta Allué Cabañuz¹, Maria Dolores Arribas Del Amo², Ismael Gil Romea², María Pilar Val-Carreres Rivera², Ramón Sousa Domínguez², Antonio Tomás Güemes Sánchez²

Affiliations

¹ Unidad de Mama, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España. Electronic address: martitaallue@hotmail.com.
² Unidad de Mama, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.

PMID: 32507308
DOI: 10.1016/j.ciresp.2020.04.028

Abstract

Introduction: Spira technique is a type of nipple-sparing mastectomy that allows immediate reconstruction (IBR), ideal for ptosic breasts. Although, controversy persists regarding oncological results in breast cancer. The aim is to analyze complications, cosmetic outcomes, causes of reoperation and oncological results.

Methods: Retrospective observational analysis of patients undergone surgery during 2003-2018 in our center. Study population is based on patients with breast carcinoma or undergoing prophylactic mastectomy due to high-risk, in which a skin-sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct to implant reconstruction was performed. Short and long-term complications, sequelae, tumor recurrence and survival rates are analyzed.

Results: A total of 247 mastectomies with immediate reconstruction in 139 patients, 216 bilateral (87.4%) and 31 unilateral (12.5%) were performed. 121 therapeutic (49%) and 126 prophylactic (51%). Median follow-up 81 months. Complications were observed in 16.2%; skin necrosis 5.3% and 5 cases of NAC necrosis (2%). Reoperation rate due to cosmetic sequelae was 17.4% (capsular contracture was the most frequent,11.3%) and a 39.3% of these patients have received RT. Recurrence of 14% (0.8% skin, 3.3% locoregional and 9.9% metastatic), 8 patients died (6.6%). Rates of FSD and OS were 92.6% and 93.3% respectively.

Conclusion: Spira mastectomy is a safe option and provides good cosmetic and oncologic results as breast cancer treatment and prophylaxis in moderate-large ptosic breasts.

Keywords: Complicaciones; Complications; Immediate breast reconstruction; Mastectomía preservadora de piel y pezón; Nipple sparing mastectomy; Reconstrucción inmediata; Secuelas; Sequelae; Spira technique; Técnica de Spira.