Aesthetic Design of Skin-Sparing Mastectomy Incisions for Immediate Autologous Tissue Breast Reconstruction in Asian Women.
10.5999/aps.2014.41.4.366
- Author:
Bien Keem TAN
1
;
Harvey CHIM
;
Zhi Yang NG
;
Kong Wee ONG
Author Information
1. Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore. bienkeem@gmail.com
- Publication Type:Original Article
- Keywords:
Mastectomy;
Mammaplasty;
Breast;
Asia;
Esthetics
- MeSH:
Asia;
Asian Continental Ancestry Group*;
Biopsy;
Breast;
Breast Neoplasms;
Cicatrix;
Esthetics;
Female;
Follow-Up Studies;
Humans;
Mammaplasty*;
Mastectomy*;
Necrosis;
Nipples;
Skin
- From:Archives of Plastic Surgery
2014;41(4):366-373
- CountryRepublic of Korea
- Language:English
-
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.
