Bilateral prophylactic skin-reducing nipple-sparing mastectomy with immediate breast reconstruction using only a vascularized dermal–subcutaneous pedicle: technique and possible advantages

Vrekoussis, Thomas; Himsl, Isabelle; Günthner-Biller, Maria; Dian, Darius

doi:10.1007/s00404-012-2636-4

Cited by 6 publications

(3 citation statements)

References 12 publications

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“…The redundant mastectomy skin within the markings of a standard Wise skin-reduction pattern 33is deepithelialized and then used to create the new breast mound. In 2013, Vrekoussis et al published a case report of a patient treated with bilateral NSM and reconstructed in a fashion similar to the Goldilocks mastectomy, except with preservation of the NAC (10). The patient had large, severely ptotic breasts.…”

Section: Local Tissue Rearrangementmentioning

confidence: 99%

Autologous reconstruction following nipple sparing mastectomy: a comprehensive review of the current literature

Shay

Jacobs

2018

Gland Surg.

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As surgical methods continue to evolve and patients become more educated consumers of their medical care, both oncologic breast surgeons and reconstructive plastic surgeons should understand the current options for surgical management of breast cancer. This review evaluates the current autologous breast reconstruction options following nipple sparing mastectomy (NSM). A comprehensive review of the current literature discussing autologous reconstruction after NSM was performed. Fat grafting alone has been used to reconstruct small to medium sized-breasts over multiple injection sessions. Goldilocks mastectomy-like reconstructions can be used for larger, more ptotic breasts. Pedicled latissimus dorsi (LD) flaps can be used, but usually need to be modified to ensure sufficient breast volume. While the lower abdominal tissue remains the most common donor site in free tissue transfer, other donor sites can be used if there is insufficient volume or inadequate perforators. Periareolar incisions are associated with the highest rates of overall complications and nipple areola complex necrosis. It has not been determined whether implant-based or autologous reconstructions have lower complication rates. Both prior radiation and large, ptotic breasts present unique challenges during reconstruction. Overall, there is a high rate of patient satisfaction with breast reconstruction following NSM. Autologous breast reconstruction after NSM is a safe method of breast cancer surgical management with aesthetically excellent results. Multiple techniques have been described along the reconstructive ladder. Special consideration should be given to choices of incision, previously irradiated breasts, and large, ptotic breasts.

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Section: Local Tissue Rearrangementmentioning

confidence: 99%

Autologous reconstruction following nipple sparing mastectomy: a comprehensive review of the current literature

Shay

Jacobs

2018

Gland Surg.

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“…Since then, several modifications regarding the submuscular pocket, NAC preservation and patterns of mastectomy have been proposed. The use of a separate superomedial flap carrying the NAC [ 7 ] or an inferiorly based NAC-bearing dermal sling [ 8 ] or a bi-pedicle McKissock style flap carrying the NAC [ 9 ] have been described for nipple areolar complex preservation. The technique has also been described for breast reconstruction after vertical-pattern [ 10 ] and modified Wise-pattern (type V) skin sparing mastectomy [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Autologous coverage for direct-to-implant pre-pectoral reconstruction in large and ptotic breasts: a new technique

Rubino,

Trignano,

Rodio

et al. 2024

Case Reports in Plastic Surgery and Hand Surgery

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Direct-to-implant (DTI) breast reconstruction after skin reducing mastectomy in large and ptotic breast is characterized by a high rate of complication. The Dermal Sling is commonly used to give extra coverage to the lower pole of the mammary implant to lower the risk of implant exposure in case of wound dehiscence at the T-junction. The aim of the paper is to detail an original technique that combines an inferior dermal sling with pectoral and serratus fascial flaps, to create a pre-pectoral pouch. We retrospectively review the clinical data of the patients who underwent Type IV/V mastectomy and DTI breast reconstruction with the described technique. Minor and major post operative complications were analyzed. Patient satisfaction and aesthetic outcomes were evaluated at one year of follow-up through Breast-Q and Validated Aesthetic Scale. Ten patients (fourteen breasts) were included in the study. Skin and/or NAC necrosis occurred in three breasts. One patient underwent implant removal due to periprosthetic infection. At one of follow-up no capsular contracture nor migration of the implant were clinically detected in all patients. One patient had a visible rippling at the upper quadrants of the new breast. Good patient satisfaction and aesthetic outcomes were reported. The association of fascial flaps and dermal sling is a viable option for breast reconstruction in patients with large and ptotic breasts. Along with providing an autologous coverage for the implant, it allows to maintain a good projection, maximize symmetrization in case of concomitant contralateral reduction mammoplasty and avoid any implant displacement.

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“…Others [25,26], instead, described their use in pre-pectoral reconstruction; matrices can be sutured to the superior border of the dermal flap and placed to cover the superior pole of the implant, or they can be used as a means for total implant coverage under the dermal flap. Different techniques have been also described to preserve the NAC, such as an inferiorly based dermal flap bearing the NAC [27] or a vertical bipedicle McKissock style flap [28]. Furthermore, an alternative reduction pattern for mastectomy skin excision has been proposed by Santanelli et al [29] for patients requiring the skin excision of an upper quadrant due to the presence of a superficially located tumor or a scar from previous surgeries (e.g., lumpectomy, quadrantectomy) that may increase the risk of Wise skin flap necrosis.…”

Section: Introductionmentioning

confidence: 99%

One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm

Rampazzo

Spissu²,

Pinna³

et al. 2023

JCM

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Immediate implant-based breast reconstruction in patients with large and ptotic breasts may be challenging due to skin redundancy. The use of a reduction mammoplasty pattern for the mastectomy skin excision has proven to be a reliable option for these patients as it allows for a better shape, projection, and symmetrization. This approach has been described in the literature for both one- and two-stage reconstruction with either sub- or pre-pectoral reconstruction with an acellular dermal matrix (ADM) or non-biological mesh. One-stage immediate breast reconstructions have a positive significant impact on patients’ psychosocial well-being and quality of life. The purpose of this paper is to describe an institutional algorithm that allows one to perform one-stage implant-based breast reconstructions in patients with large and ptotic breasts.

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Bilateral prophylactic skin-reducing nipple-sparing mastectomy with immediate breast reconstruction using only a vascularized dermal–subcutaneous pedicle: technique and possible advantages

Abstract: We believe that such technique in selected cases can present several advantages as low cost, reduced possibilities for complications associated to implant insertion or autologous reconstruction techniques and an easier mammography follow-up.

Cited by 6 publications

References 12 publications

Autologous reconstruction following nipple sparing mastectomy: a comprehensive review of the current literature

Autologous reconstruction following nipple sparing mastectomy: a comprehensive review of the current literature

Autologous coverage for direct-to-implant pre-pectoral reconstruction in large and ptotic breasts: a new technique

One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm

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