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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Skin-reducing mastectomy with breast reconstruction and sub-pectoral implants
G Querci della Rovere1, M Nava, R Bonomi
1Department of Surgery, The Royal Marsden Hospital, Down's Road, Sutton, Surrey SM2 5PT, UK. gquercidellarovere@doctors.org.uk
Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|August 19, 2007
Summary
Skin-reducing mastectomy (SRM) improves immediate breast reconstruction by creating a better lower pouch. This technique offers good cosmetic results and satisfactory implant coverage with reduced scarring.
Area of Science:
- Plastic Surgery
- Oncology
- Breast Reconstruction
Background:
- Immediate breast reconstruction using sub-pectoral tissue expanders faces challenges in shaping the lower medial pouch due to pectoral muscle insertion.
- This often necessitates delayed procedures to achieve optimal cosmetic outcomes, particularly fullness in the lower medial quadrant.
Purpose of the Study:
- To evaluate the efficacy of skin-reducing mastectomy (SRM) in addressing cosmetic challenges in immediate breast reconstruction.
- To assess the oncological safety and cosmetic benefits of the SRM technique.
Main Methods:
- Skin-reducing mastectomy (SRM) creates a dermomuscular pouch for improved lower-medial volume and implant coverage.
- Utilized permanent expanders and matched flap length to pouch dimensions to minimize complications.
- Indications align with skin-sparing mastectomy, suitable for large breasts and high-risk prophylactic mastectomies.
Main Results:
- The study included 18 SRMs in 10 women.
- A low complication rate of 5% (hematoma and infection) was observed.
- A 5% rate of poor long-term cosmetic result (lower pole fibrosis) was reported.
Conclusions:
- Skin-reducing mastectomy (SRM) is an oncologically sound, skin-sparing approach (Type IV) for breast reconstruction.
- SRM effectively creates a dermomuscular pouch, yielding good cosmetic results and addressing lower-medial quadrant volume issues.