Aesthetic Design of Skin-Sparing Mastectomy Incisions for Immediate Autologous Tissue Breast Reconstruction in Asian Women

다국어 초록 (Multilingual Abstract)

Background: The advent of skin-sparing mastectomy has allowed for the reconstruction ofthe breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC) inAsian patients is more pigmented and scars easily. Therefore, commonly described incisionstend to result in poor aesthetic outcomes in Asian patients with breast cancer.
Methods: We describe an algorithmic approach to skin-sparing mastectomy incisions inAsian 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 distantskin paddle, “racquet handle,” and peri-areolar with adjacent skin excision.
Results: 281 immediate breast reconstructions were performed between May 2001 andFebruary 2012 after skin-sparing mastectomy. The mastectomy incisions used included theperi-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 skinexcision (n=42, 14%). The traditional elliptical incision and other variants where the NACoutline was not preserved were performed in the remaining 55 patients. The average followupwas 44.7 months during which there was 1 case of total flap loss and 7 cases of partial flapnecrosis; all remaining flaps survived. 24% of the patients (68/281) underwent subsequentnipple reconstruction.
Conclusions: Our algorithm avoids breast incisions that are randomly placed or excessivelylong and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparingmastectomy and immediate breast reconstruction to be performed with a consistentlyachievable aesthetic result in Asian women without neglecting oncological safety.

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