ABSTRACT
Mastectomy has evolved from approaches that involved extensive skin resection to nipple-sparing mastectomy (NSM). However, patients with advanced breast cancers who require extensive skin resection usually also have their nipple areola complexes (NACs) removed, even if they are distant from the cancer. Implant reconstruction in these patients is challenging as they require tissue expansion and, typically, radiotherapy with additional surgeries to complete their reconstruction. The aesthetic results of this approach are inferior to NSM and direct-to-implant reconstruction. In patients who require significant skin resection but whose NACs are free of tumor, we have found that immediate skin replacement using a muscle-sparing latissimus dorsi flap allows for NSM and direct-to-implant reconstruction, obviating the need for tissue expansion, delayed implant placement, and NAC reconstruction. Here, we report on 12 patients in whom this approach is utilized.
ABSTRACT
Implant-based breast reconstruction after bilateral mastectomy allows for excellent symmetry between the reconstructed breasts. After unilateral mastectomy, it is difficult to achieve symmetry between the reconstructed and native breast. In the past, anatomical implants provided a reconstruction that more closely resembled the shape of a native breast compared with the cohesive, round subpectoral implants commonly placed today. Here, we describe the use of a less form-stable round implant placed in the prepectoral plane after mastectomy which provides improved symmetry with the contralateral native breast.
