Mastectomy and Immediate Expander/Implant Reconstruction with Lipofilling: Postmastectomy Radiation Treatment

Fig. 59.1

(a, b) A 48-year-old patient presented with a locally advanced cancer of the left breast. Axillary lymph node status was positive

Mammography, breast sonography, and MRI found a 50 mm tumor and positive axillary nodes.

Neoadjuvant chemotherapy was suggested. Following 4 cycles of epirubicin and cyclophosphamide and 4 cycles of docetaxel, the patient showed a clinically and radiologically complete remission. Mastectomy was planned with immediate expander reconstruction; postmastectomy radiation treatment (PMRT) was suggested. The breast was of small size and non-ptotic (Fig. 59.2a, b).

Fig. 59.2

(a, b) Following neoadjuvant chemotherapy, a complete clinical and radiological remission was found. The breast was of small size and non-ptotic. Mastectomy and immediate reconstruction with an expander were planned

59.2 Surgery

Mastectomy was performed with wide resection of the skin. Sentinel node biopsy found two negative sentinel nodes, but due to positive axillary nodes prior to chemotherapy, axillary lymph node sampling was done. A 350 cc anatomical expander was inserted totally submuscularly under the pectoralis major muscle and the serratus anterior muscle and filled with 50 cc of saline solution.