Single-stage, autologous breast restoration.

Breast reconstruction following mastectomy has evolved significantly, particularly with the introduction of skin-sparing techniques. Prior research has shown that traditional methods often required multiple procedures, especially for the nipple-areola complex. However, a gap remained in determining whether one-stage reconstruction could safely include the nipple-areola complex while preserving aesthetics. Recent studies have suggested that patients with early-stage breast cancer and peripherally located tumors have a low risk of nipple involvement. This uncertainty drove the need to explore single-stage reconstruction methods that include the nipple-areola complex. No prior work had resolved how to retain the complex while ensuring safety and cosmetic outcomes. The use of a buried transverse rectus abdominis musculocutaneous (TRAM) flap has been established, but its application in one-stage reconstruction with the nipple-areola complex remained untested in a broader clinical setting. The study aimed to address this gap by evaluating the feasibility and outcomes of a single-stage approach.

The purpose of this study was to assess the safety and cosmetic outcomes of a single-stage autologous breast and nipple-areola reconstruction. The specific problem addressed was whether the nipple-areola complex could be safely retained in patients undergoing immediate reconstruction. The motivation stemmed from the low risk of tumor involvement in the nipple-areola complex for patients with early-stage disease and peripherally located tumors. The authors aimed to determine if a thin full-thickness skin graft could be used to preserve the original breast envelope. This approach was expected to improve color and texture matching in reconstructions. The study also aimed to evaluate patient satisfaction and identify potential complications such as flap necrosis. By integrating the reconstruction of the breast and nipple-areola complex in one stage, the authors sought to streamline the surgical process and reduce the need for multiple procedures. The findings could inform future guidelines on optimal reconstruction techniques.

The study involved 17 patients who underwent one-stage breast and nipple-areola reconstruction. A buried transverse rectus abdominis musculocutaneous (TRAM) flap was used in all cases. Simultaneous reconstruction of the nipple-areola complex was performed in each patient. Nine patients had a Wise keyhole pattern used with contralateral reduction. Four patients retained all their breast skin, while another four used a TRAM skin island. For patients with early-stage disease and peripheral tumors, a thin full-thickness graft was applied to a deepithelialized CV flap. The graft was removed from the breast in an apple-coring fashion to preserve ducts. Histological confirmation of tumor absence in the nipples was obtained. The surgical approach combined skin-sparing mastectomy with immediate reconstruction. The use of a buried TRAM flap minimized visible scarring. The study focused on evaluating cosmetic outcomes and patient satisfaction.

The study demonstrated that one-stage autologous reconstruction is feasible for patients undergoing immediate breast reconstruction. In 10 patients with early-stage disease and peripheral tumors, the areola was retained as a thin full-thickness graft. In three patients with early-stage disease, the entire nipple-areola complex was used as a graft. Histological confirmation showed no tumor presence in the nipples of these patients. The use of a thin full-thickness graft allowed for ideal color and texture matching in reconstructions. Patient satisfaction was high overall. However, some patients experienced flap necrosis, which impaired cosmetic results. The study found that the best method of reconstruction involved retaining the original breast envelope. The approach was particularly effective in patients with peripherally located tumors. The study also noted that the use of a buried TRAM flap contributed to favorable outcomes.

The authors concluded that one-stage autologous reconstruction should be considered for patients undergoing immediate breast reconstruction. The use of a thin full-thickness graft for the nipple-areola complex in patients with early-stage disease and peripheral tumors is a viable option. The graft allows for ideal color and texture matching in reconstructions. Histological confirmation of tumor absence in the nipples supports the safety of this approach. The study found that retaining the original breast envelope improves cosmetic outcomes. However, flap necrosis was observed in some patients, indicating potential risks. The authors propose that a large multicenter study is needed to confirm the effectiveness of this procedure. The findings suggest that one-stage reconstruction may reduce the need for multiple procedures and improve patient satisfaction.