Immediate microsurgical breast reconstruction following vertical incision mastectomy in patients with ptotic breasts: An international multicenter case series

Skin-sparing mastectomies often require reshaping of the skin envelope, particularly in patients with ptotic breasts. However, this reshaping can result in skin necrosis. A vertical skin resection technique, combined with immediate autologous breast reconstruction, has been developed to address this challenge. This study aims to describe this surgical approach and evaluate its outcomes.

Between January 2019 and March 2023, 35 patients with grade 2 and 3 ptosis and a BMI of over 25 underwent skin-sparing mastectomy followed by immediate autologous breast reconstruction. The procedure involved the vertical skin resection approach combined with a free flap.

Of the 35 patients, 15 (42.9%) had grade II ptosis, and 20 (57.1%) had grade III ptosis. Thirty-three patients underwent DIEP (Deep Inferior Epigastric Perforator) flap, and 2 patients had a TUG (Transverse Upper Gracilis) flap. The average resection weight was 575g for the DIEP group and 482g for the TUG group. All vascular anastomoses were performed on the internal mammary vessels, with 22 flaps (56.4%) requiring superficial vein anastomosis in the axilla. One breast (2.6%) developed vertical wound dehiscence, and another suffered DIEP flap failure. No skin envelope necrosis was observed. There were no local recurrences or metastases, with an average follow-up of 18 months [4 months-6 years]. Aesthetic outcomes were satisfactory.

The vertical skin resection technique in skin-sparing mastectomy improves aesthetic outcomes for patients needing reshaping of the breast envelope. This approach preserves vascular integrity and provides easy access to the axillary area, without compromising oncological safety.