Minimal injury mastectomy in the surgical treatment of stage I and II breast cancer patients. A 20-year experience.

The main purpose of the present study is to enhance what we coined minimal injury mastectomy (MIM) as a reliable, efficient and acceptable procedure in the surgical treatment of breast cancer besides other therapeutic options currently used in the setting of adjuvant treatment (e.g. radiation therapy, chemotherapy or hormonal manipulations). We analysed retrospectively data of 142 patients with stage I and II breast cancer. Fifty-five of them had stage I, and the remaining 87 patients had stage II disease. Patients were submitted to minimal injury mastectomy, which is a broad segmental mastectomy, with limited or no axillary lymphadenectomy, thus minimizing locoregional trauma. Radiotherapy was given on a selective basis. Postoperative follow-up period ranged from one to 19.5 years (mean 103.5 months). Cosmetic results, shoulder function, texture of the breast and patient psychology were excellent in all the patients. In 55 stage I patients, six local recurrences occurred (12.72%), a mean 49.9 months after MIM, with ultimate local control of all patients and a remarkable survival after treatment of recurrences. In 87 stage II patients, six local (6.8%) and 16 systemic recurrences (18.7%) occurred, the latter after a mean period of 54.4 months postoperatively. It is concluded that with the minimal injury mastectomy, locoregional injury is minimized, preserving the regional immunological functions and by preventing lymphedema of the remaining breast, systemic resistance mechanisms are maintained and other adverse factors are avoided.