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Background: There is limited evidence on the ideal retention thickness of skin flap in mastectomy. Residual breast tissue (RBT) after mastectomy still represents an unknown risk for local recurrence or new breast cancer lesions. We made this systematic review to identify the optimal flap after mastectomy with minimal complications and better oncological safety.

Methods: A systematic review was performed using MEDLINE search in PubMed, Embase, and Cochrane Library with the search terms relevant to skin flap thickness and residual breast tissue in breast cancer patients undergoing mastectomy.

Results: Twenty-one studies were included of which fifteen studies enrolled 3814 patients who received mastectomy, and additional six studies were based on cadavers or breast specimens. Four studies confirmed the presence of the superficial fascial layer (Camper's fascia) which can theoretically be used as an anatomical marker for flap retention during mastectomy. Two other studies confirmed Camper's fascia deficiency to a greater or lesser extent. The flap thickness ranged from 3.8 mm to 23 mm in 2692 patients of 7 studies, which was related to BMI, breast size, and examination modalities. Two retrospective and one prospective studies confirmed flaps exceeding 5 mm could significantly increase postoperative complications. Nine studies including 1122 patients explored the association among flap thickness, RBT, and complications, 3 studies of which confirmed excessive flap thickness could cause a significant increase in RBT, which proved to be a potential risk factor for local recurrence in 3 studies. Flaps beyond 5 mm were also found to significantly increase the chance of local recurrence in 4 studies.

Conclusion: Camper's fascia can serve as an ideal demarcation between fat and breast tissue based on most current studies. 5 mm thickness of the flap retention in mastectomy is recommended if Camper's fascia is absent or obscure, through which better cosmetic outcomes and less RBT can be achieved.

Titel:	Updated findings of skin flap thickness and residual breast tissue after mastectomy for breast cancer: a systematic review of the literature.
Autor/in / Beteiligte Person:	Lv, W ; Fu, P ; Wu, P
Zeitschrift:	Updates in surgery, Jg. 76 (2024-06-01), Heft 3, S. 829-838
Veröffentlichung:	Milano : Springer-Verlag Italia, 2024
Medientyp:	academicJournal
ISSN:	2038-3312 (electronic)
DOI:	10.1007/s13304-023-01675-5
Schlagwort:	Humans Female Breast surgery Breast pathology Postoperative Complications etiology Mammaplasty methods Neoplasm Recurrence, Local epidemiology Breast Neoplasms surgery Breast Neoplasms pathology Surgical Flaps Mastectomy methods
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Systematic Review; Journal Article; Review Language: English [Updates Surg] 2024 Jun; Vol. 76 (3), pp. 829-838. <i>Date of Electronic Publication: </i>2023 Oct 21. MeSH Terms: Breast Neoplasms* / surgery ; Breast Neoplasms* / pathology ; Surgical Flaps* ; Mastectomy* / methods ; Humans ; Female ; Breast / surgery ; Breast / pathology ; Postoperative Complications / etiology ; Mammaplasty / methods ; Neoplasm Recurrence, Local / epidemiology References: Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 88:105906. (PMID: 3378982610.1016/j.ijsu.2021.105906) ; Muntan CD, Sundine MJ, Rink RD et al (2000) Inframammary fold: a histologic reappraisal. Plast Reconstr Surg 105(2):549–556 (discussion 557). 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Updated findings of skin flap thickness and residual breast tissue after mastectomy for breast cancer: a systematic review of the literature.