Aesthetic refinement in breast reconstruction: complete skin-sparing mastectomy with autogenous tissue transfer

Aesthetic results in breast reconstruction are often compromised either by prominent scars or by the presence of an island of skin that differs in color and texture from the native breast skin. Complete skin-sparing mastectomy is a technique by which breast scars can be largely eliminated and the need for a visible skin island avoided. A circumareolar incision is used for mastectomy with a separate axillary incision if needed. Autogenous tissue is used to fill the skin envelope, and a disk of skin temporarily replaces the areola. Twenty-eight patients treated by this method were reviewed retrospectively. Prerequisites included a favorable biopsy scar location and a suitable tissue donor site. The mean patient age was 42.5 years, and the majority were reconstructed with TRAM flaps (92 percent). There was no evidence of increased morbidity or any instance of local recurrence during a follow-up period, which averaged 25.7 months. Aesthetic results were judged excellent in 12 patients, good in 11 patients, and fair in 5 patients. Insufficient tissue volume, shape asymmetry, and areolar position asymmetry were the most common factors that detracted from the quality of the results. Advantages of this method, besides the prospect of an ideal aesthetic result, include easier flap insetting and simplified subsequent revision procedures. Disadvantages include the requirement of a skilled ablative surgeon and incompatibility with conventional expander/implant methods of reconstruction.