The “Type V” Skin-Sparing Mastectomy for Upper QuadrantSkin Resections

Santanelli, Fabio; Paolini, Guido; Campanale, Antonella; Longo, Benedetto; Amanti, C.

doi:10.1097/sap.0b013e3181c60f41

Cited by 22 publications

(20 citation statements)

References 27 publications

(18 reference statements)

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“…The aim of this report was to illustrate how the same goal can be achieved in patients with large, ptotic breasts, but with tumor lying superficially in the SSQQ or deep to the The reported procedure entails a modified WP-SSM for upper quadrant skin resection, as described by Santanelli et al, [9,10] followed by immediate DIEP flap reconstruction and a contralateral symmetrization procedure. With the patient in standing position the median breast line was marked and the new nipple position was located at 23 cm from the sternal notch, then the WP was marked bilaterally.…”

Section: Discussionmentioning

confidence: 99%

A novel approach to achieve breast symmetry in a single-stage procedure

Longo¹,

Laporta²,

Pagnoni³

et al. 2015

Plast Aesthet Res

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Preservation of the skin envelope and the inframammary fold is the main factor in achieving breast symmetry in unilateral reconstruction. Skin sparing mastectomy (SSM) type-IV followed by immediate autologous reconstruction and contralateral symmetrization permits realizing this goal in large, ptotic breasted patients, and tumor superficially located in the inferior quadrants. If the tumor is superficially located in the superior or inferior quadrants with a previous lumpectomy or quadrantectomy scar in the superior quadrants, modified radical mastectomy and a staged procedure are recommended to avoid poor cosmetic results. Two patients who underwent immediate autologous reconstruction following SSM type-V with contralateral symmetrization in a one-stage procedure are presented.

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Section: Discussionmentioning

confidence: 99%

A novel approach to achieve breast symmetry in a single-stage procedure

Longo¹,

Laporta²,

Pagnoni³

et al. 2015

Plast Aesthet Res

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“…Inter‐rater reliability was calculated for each of the picture grading subscales using the Cohen's Kappa . The strength of agreement was classified based on the ĸ score as follows: less than 0.00, poor; 0.00 to 0.20, slight; 0.21 to 0.40, fair; 0.41 to 0.60, moderate; 0.61 to 0.80, substantial; and 0.81 to 1.00, almost perfect agreement …”

Section: Methodsmentioning

confidence: 99%

One‐stage DIEP flap breast reconstruction: Algorithm for immediate contralateral symmetrization

et al. 2015

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The aim of this study was to investigate clinical and aesthetic results of simultaneous contralateral balancing procedures in unilateral DIEP flap reconstructions by means of a symmetrization algorithm. Between 2004 and 2013, 335 patients underwent DIEP flap breast reconstruction with 48 patients (mean age 51.8 years, range 32-69 years) undergoing contralateral procedure. Patients were divided in Group-A including 31 cases who underwent one-stage procedure and Group-B including 17 cases who underwent staged procedure. A symmetrization algorithm was proposed to plan immediate breast reduction/mastopexy. The groups were homogeneous regarding patient's age, BMI, mastectomy and flap weight (P > 0.05). All flaps survived. No complications were observed to the mastectomy skin flaps and to the reduction mammaplasty/mastopexy procedures in both groups. The mean operation time was 5 h in Group-A while 5 h and 37 min in Group-B (P = 0.0682). Contralateral procedures included 23 breast reductions and 8 mastopexies in Group-A, while 10 breast reductions and 7 mastopexies were performed in Group-B. Two and 6 patients required revision of the balancing procedure in Group-A and Group-B, respectively. The follow-up time was 47.3 months (range 14-120 months) in Group-A and 91.3 months (range 41-110 months) in Group-B. Volume, upper/lower pole shape, projection, breast mound placement, IMF, symmetry, overall appearance, and general satisfaction sub-items obtained high-score evaluation without significant difference between the two groups (P > 0.05). One-stage DIEP flap reconstruction by means of the symmetrization algorithm resulted in comparable aesthetic outcomes and patient satisfaction to a staged procedure.

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“…Types I, II, and III refer to small breast and mastectomy through a periareolar access, whereas type IV refers to large, ptotic breast, and mastectomy through a Wise‐pattern incisions . Santanelli et al proposed a modification of the skin‐sparing mastectomy type IV (the type V) extending its indications to women with large and ptotic breasts requiring skin excision because of cancer superficially located in upper quadrants, and to patients with high risk of mastectomy skin flaps necrosis because of the scar located in the upper‐quadrant following previous lumpectomy/quadrantectomy …”

Section: Methodsmentioning

confidence: 99%

“…a and b). In the “type V” skin‐sparing mastectomy for upper quadrant skin resections, a round 4 cm diameter SP was marked at the center of the flap with an additional elliptical/triangular skin island that could be oriented in the medial/lateral or superior position (Figs. a and b).…”

Section: Methodsmentioning

confidence: 99%

Diep flap sentinel skin paddle positioning algorithm

et al. 2014

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Although clinical examination alone or in combination with other techniques is the only ubiquitous method for flap monitoring, it becomes problematic with buried free-tissue transfer. We present a DIEP flap sentinel skin paddle (SSP) positioning algorithm and its reliability is also investigated using a standardized monitoring protocol. All DIEP flaps were monitored with hand-held Doppler examination and clinical observation beginning immediately after surgery in recovery room and continued postoperatively at the ward. Skin paddle (SP) position was preoperatively drawn following mastectomy type incisions; in skin-sparing mastectomies types I-III a small SP (sSP) replaces nipple-areola complex; in skin-sparing mastectomy type IV, SSP is positioned between wise-pattern branches while in type V between medial/lateral branches. In case of nipple-sparing mastectomy SSP is positioned at inframammary fold or in lateral/medial branches of omega/inverted omega incision if used. Three hundred forty-seven DIEP flap breast reconstructions were reviewed and stratified according to SP type into group A including 216 flaps with large SP and group B including 131 flaps with SSP and sSP. Sixteen flaps (4.6%) were taken back for pedicle compromise, 13 of which were salvaged (81.25%), 11 among 13 from group A and 2 among 3 from group B. There was no statistical difference between the groups concerning microvascular complication rate (P = 0.108), and time until take-back (P = 0.521) and flap salvage rate (P = 0.473) resulted independent of SP type. Our results suggest that early detection of perfusion impairment and successful flaps salvage could be achieved using SSP for buried DIEP flap monitoring, without adjunctive expensive monitoring tests.

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The “Type V” Skin-Sparing Mastectomy for Upper QuadrantSkin Resections

Cited by 22 publications

References 27 publications

A novel approach to achieve breast symmetry in a single-stage procedure

A novel approach to achieve breast symmetry in a single-stage procedure

One‐stage DIEP flap breast reconstruction: Algorithm for immediate contralateral symmetrization

Diep flap sentinel skin paddle positioning algorithm

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