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Arch Plast Surg. 2014 Jul;41(4):366-73. doi: 10.5999/aps.2014.41.4.366. Epub 2014 Jul 15.

Aesthetic design of skin-sparing mastectomy incisions for immediate autologous tissue breast reconstruction in asian women.

Author information

1
Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
2
Division of Plastic Surgery, Department of Surgery, University of Miami, Miami, FL, USA.
3
Department of Surgical Oncology, National Cancer Centre, Singapore.

Abstract

BACKGROUND:

The advent of skin-sparing mastectomy has allowed for the reconstruction of the breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC) in Asian patients is more pigmented and scars easily. Therefore, commonly described incisions tend to result in poor aesthetic outcomes in Asian patients with breast cancer.

METHODS:

We describe an algorithmic approach to skin-sparing mastectomy incisions in Asian patients on the basis of the location of the biopsy scar and the tumor site and size. Four incision types are described: peri-areolar, a peri-areolar incision with a second distant skin paddle, "racquet handle," and peri-areolar with adjacent skin excision.

RESULTS:

281 immediate breast reconstructions were performed between May 2001 and February 2012 after skin-sparing mastectomy. The mastectomy incisions used included the peri-areolar design (n=124, 44%), peri-areolar design with a second distant skin paddle (n=39, 14%), "racquet handle" (n=21, 7.5%), and peri-areolar design with adjacent skin excision (n=42, 14%). The traditional elliptical incision and other variants where the NAC outline was not preserved were performed in the remaining 55 patients. The average follow-up was 44.7 months during which there was 1 case of total flap loss and 7 cases of partial flap necrosis; all remaining flaps survived. 24% of the patients (68/281) underwent subsequent nipple reconstruction.

CONCLUSIONS:

Our algorithm avoids breast incisions that are randomly placed or excessively long and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparing mastectomy and immediate breast reconstruction to be performed with a consistently achievable aesthetic result in Asian women without neglecting oncological safety.

KEYWORDS:

Asia; Breast; Esthetics; Mammaplasty; Mastectomy

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