Many surgical guidelines promote the removal of the pectoral fascia in mastectomies for invasive breast cancer, but there is no evidence to support this statement in (bilateral) prophylactic mastectomies. Reported wound-related local complications following mastectomy include seroma, flap necrosis, infection, hematoma, and nerve injury. Seroma causes discomfort and may delay the reconstructive procedures. Whether the removal or preservation of the pectoral fascia influences seroma formation following mastectomy remains unclear to our knowledge.
The primary objective of this pilot study is to investigate the impact of removal versus preservation of the pectoral fascia on drain policy and needle aspirations in women who undergo a bilateral prophylactic mastectomy. The secondary objective is to investigate the impact of removal versus preservation of the pectoral fascia on postoperative (surgical) complications. The study design includes a double-blinded, prospective, randomized controlled pilot study with a within-subject design. All patients will undergo a bilateral prophylactic mastectomy and randomization will occur within the patient. Preservation of the PF will be performed in one breast (intervention), while removal of the PF will be performed in the contralateral breast of the same patient (control). Consequently, the operation involves a total bilateral prophylactic mastectomy, with unilateral preservation of the PF The follow-up time of each patient will be 6 weeks. The patients' files will be viewed after the removal of the drain for additional recorded variables.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
21
A total mastectomy will be performed in the control breast: a procedure which includes removal of the breast glandular tissue including the PF and subcutaneously excision of the nipple-areolar complex, while the pectoralis muscle will be spared. As much of the healthy skin envelope will be preserved to enable the performance of an effective breast reconstruction afterwards. When a nipple-sparing mastectomy is performed, the skin envelope together with the nipple-areolar complex will be spared. The investigational part of the operation is preservation of the PF. Dissection of cutaneous flaps and the breast with or without the PF will be performed with electrocautery.
Erasmus Medical Center
Rotterdam, Netherlands
RECRUITINGDrainproduction in milliliters
The total drainage volume of the left and right breast in milliliters
Time frame: Until drain removal, maximum 1 week
Time to drain removal in days
Number of days until drain removed
Time frame: Until drain removal, maximum 1 week
Seroma (yes/no)
Occurrence of seroma
Time frame: Up to 6 weeks
Needle aspirations (number)
Number of needle aspirations
Time frame: Up to 6 weeks
Postoperative pain (score 1-10)
Postoperative pain measured with Visual Analogue Scale
Time frame: Up to 6 weeks
Postoperative bleeding (yes/no)
Occurrence of postoperative bleeding
Time frame: Up to 6 weeks
Wound related issues (yes/no)
Wound related issues such as hematoma or infection
Time frame: Up to 6 weeks
Hospitalization duration (in days)
Duration of hospitalization, including readmissions
Time frame: Up to 6 weeks
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