The significance of biopsy scar excision at the time of skin- or nipple-sparing mastectomy with immediate breast reconstruction.
BACKGROUND
Neoplastic seeding (NS) can occur after tissue biopsy, which is a clinical issue especially in mastectomy with immediate reconstruction. This is because postoperative radiation is not usually given and local recurrence of preserved skin flap may increase. The purpose of this study is to investigate the importance of preoperative evaluation of NS and the validity of biopsy scar excision.


PATIENTS AND METHODS
We retrospectively analysed 174 cases of mastectomy with immediate breast reconstruction. The primary endpoint is the frequency of clinical and pathological NS and the secondary endpoint is the problem of excision of needle biopsy site.


RESULTS
Three cases (1.7%) had preoperative clinical findings of NS. Pathological examination revealed NS in all three cases. Biopsy scars could be excised in 115 cases among 171 cases without clinical NS. Pathological NS was found in 1 of 66 (1.5%) cases of which pathological examination was performed. Biopsy scars could not be excised in the remaining 56 cases: the biopsy scar could not be identified in 41 cases, and there was concern about a decrease in flap blood flow after excision in 15 cases. In 12 of these 15 cases, the scars were close to the skin incision; excision of these scars might have triggered skin necrosis between the incision and the biopsy scar excision site. No postoperative complications were observed.


CONCLUSIONS
It is important to preoperatively evaluate clinical NS, and biopsy scars should be excised in clinical NS cases. Even in cases without clinical NS, biopsy scar excision should be considered. It is also important to perform a biopsy in consideration of the incision design for reconstructive surgery.
['Ozaki|Yuri|Y|', 'Yoshimura|Akiyo|A|', 'Sawaki|Masataka|M|', 'Hattori|Masaya|M|', 'Kotani|Haruru|H|', 'Adachi|Yayoi|Y|', 'Kataoka|Ayumi|A|', 'Sugino|Kayoko|K|', 'Horisawa|Nanae|N|', 'Endo|Yuka|Y|', 'Nozawa|Kazuki|K|', 'Sakamoto|Shoko|S|', 'Takatsuka|Daiki|D|', 'Okumura|Seiko|S|', 'Maruyama|Yoko|Y|', 'Iwata|Hiroji|H|']
D001706:Biopsy D001943:Breast Neoplasms D002921:Cicatrix D005260:Female D006801:Humans D016462:Mammaplasty D008408:Mastectomy D009364:Neoplasm Recurrence, Local D009558:Nipples D012189:Retrospective Studies
biopsy scar breast reconstruction neoplastic seeding breast cancer