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View pdf in Journal of Plastic, Reconstructive & Aesthetic Surgery
Diagnosing a recurrence or primary tumor in a woman with breast reconstruction using implants represents a double challenge for the surgeon. First, complete extirpation of the tumor and the compatibility of the procedure with the rest of the oncologic treatments (chemotherapy, radiation therapy) need to be ensured. Second, the preservation of the reconstructed breast should be assessed using a procedure that ensures both its preservation and a minimum of cosmetic deterioration. The transcapsular approach is a previously undescribed procedure that meets these 2 requirements for tumor extirpation in patients with breast reconstruction using implants and is characterized by low morbidity and high resolution for the tumor extirpation.
This procedure is based on opening the periprosthetic capsule and withdrawing the implant to access the tumor bed, located in the subcutaneous area, through the capsular cavity itself. The procedure involves simple access, with low morbidity and that, in most cases, allows the original reconstruction to be preserved. The access can be achieved through the previous scars or through an incision in the inframammary fold, the latter of which allows for good access to the tumors located in the upper pole, medial quadrants and lateral quadrants. The preservation of the implant in an antibiotic solution during the surgery allows for its reuse once the tumor extirpation has been completed. This approach is designed for extirpating tumors measuring less than 2 cm (T1) that are located in the subcutaneous tissue of the mastectomy. Most of these tumors are diagnosed during the follow-up in an MRI study or by the patient through palpation. The implementation of primary systemic therapy for tumors with a high probability of a complete pathologic response facilitates this procedure because it allows for reduced extirpation of the tumor bed, as was the case for one of our patients with a triple-negative tumor. In short, this procedure is aimed at women who underwent mastectomy for breast cancer and were subsequently diagnosed with a recurrent tumor or a new primary tumor in the mastectomy flap and at women who underwent RRM and who present a primary tumor in the RGT.