Secondary Logo

Journal Logo

Contribution to Histologic Analysis of Mastectomy Scars following Breast Reconstruction

Agostini, Tommaso, M.D.; Mori, Andrea, M.D.; Dini, Mario, M.D., Ph.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 2197-2198
doi: 10.1097/PRS.0b013e3181bcf612
LETTERS
Free

Department of Plastic and Reconstructive, University of Florence, Florence, Italy

Correspondence to Dr. Agostini, Department of Plastic and Reconstructive Surgery, University of Florence, Largo Palagi 1, Florence 50134, Italy, tommasoagostini@ymail.com

Back to Top | Article Outline

Sir:

We would like to report our data and behavior with regard to histologic analysis of mastectomy scars following breast reconstruction. Warner et al. reported an impressive record of cases, counting 433 patients who had 455 scars histologically processed.1 The authors identified four mastectomy scars infiltrated in three patients (0.9 percent). Interestingly, the patient in case 1 underwent mastectomy after wide local excision and the patient described in case 3 underwent wide local excision and salvage mastectomy because of local recurrence 5 years later; the patient in case 2 had axillary lymph node involvement and underwent bilateral mastectomy, which proves advanced, aggressive disease.

Two of three patients had a conservative approach (wide local excision), validating their further statement that locoregional recurrences are higher following breast-conservation therapy. On the contrary, the patient in case 2 had advanced, aggressive disease with nodal involvement and underwent radical mastectomy.

We submitted 72 scars for histopathologic examination. All samples were harvested at the time of definitive implant placement in patients who had had previous immediate breast reconstruction with a tissue expander after radical mastectomy. Formalin-preserved scars were sectioned and random sampled using hematoxylin and eosin staining and microscopic examination. No positive sample has been recorded. The average age at the time of reconstruction was 51.6 years (range, 22 to 72 years), and the mean interval from mastectomy to scar sampling was 16 months (range, 6 to 22 months).

We routinely submit mammary scars for histopathologic examination if some remodeling surgery after breast-conservation surgery is requested. In our opinion, histopathologic examination of radical mastectomy scars does not add further benefit. Nonetheless, we agree with the authors' statement that the question of what percentage of scar recurrence is significant and needs histologic processing is open.

Scar involvement after skin-sparing or nipple-sparing mastectomy, which have in selected cases the same local recurrence rate as radical mastectomy, should be investigated. Indeed, the risk of locoregional recurrence is dependent on several other factors, such as histologic type of tumor, lymph node involvement, adjuvant therapy, follow-up, and histopathologic processing which, as a whole, make standardizing collected data difficult.

Tommaso Agostini, M.D.

Andrea Mori, M.D.

Mario Dini, M.D., Ph.D.

Department of Plastic and Reconstructive

University of Florence

Florence, Italy

Back to Top | Article Outline

DISCLOSURE

The authors have no commercial associations that may pose or create a conflict of interest with information presented in this letter.

Back to Top | Article Outline

REFERENCE

1.Warner RM, Wallace DL, Ferran NA, et al. Mastectomy scars following breast reconstruction: Should routine histologic analysis be performed? Plast Reconstr Surg. 2009;123:1141–1147.

Section Description

GUIDELINES

Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/.

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

©2009American Society of Plastic Surgeons