One-stage immediate breast and nipple-areolar reconstruction with autologous tissue I: a preliminary report

This preliminary report discusses 7 patients with early breast cancer (mean age, 48 years) who underwent one-stage breast reconstruction. Reconstruction was achieved using a deepithelialized transverse rectus abdominis musculocutaneous (TRAM) flap placed in a pocket created by a skin-sparing mastectomy. Areolar reconstruction is performed by harvesting the areola as a full-thickness graft from the mastectomy specimen, and nipple reconstruction is achieved with a CV flap (in zone II of the TRAM flap), which is deepithelialized and covered with a full-thickness graft from the areola. In all patients a contralateral reduction or mastopexy was performed. Recent evidence suggests that not all patients with early breast cancer have areolar involvement, and that certain prognostic factors can be used to predict the likelihood of tumor involvement. A number of large studies have shown that in patients with early breast cancer, when the tumor is situated more than 5 cm from the nipple-areolar complex, tumor involvement of the nipple-areolar complex is most unlikely. No patients in this study had histological evidence of nipple involvement by cancer. The aesthetic results were very satisfactory in 5 of 7 patients. One patient who developed sepsis of the TRAM flap had an unsatisfactory result. The other complications that occurred were minor and self-limiting. The advantages of single-stage breast reconstruction are financial and psychological. In addition, the patient attains homogenous nipple-areolar reconstruction. Areolar reconstruction is achieved with the best possible option--areola. This preliminary report suggests that in a select group of patients with early breast cancer, when the tumor is more than 5 cm from the nipple-areolar complex, the areola may be preserved. The aesthetic results in these patients was considered satisfactory. However, long-term studies are required to confirm the oncological safety of this technique.