IMMEDIATE BREAST RECONSTRUCTION FOR BREAST-CARCINOMA USING THE PERIAREOLAR APPROACH

Skin-sparing mastectomy with immediate breast reconstruction has shown to be oncologically safe while: providing dependable aesthetic result s. However, flap inset into the skin defect of the excised biopsy site and nipple-areola complex often results in a patchlike effect and tra nsverse scars. By keeping the mastectomy incision solely around the ar eola, all breast skin can be preserved. Thus, in immediate breast reco nstruction with replacement of the nipple and areola bg; a small skill island from a deepithelialized TRAM flap or latissimus dorsi muscle f lap, the scar is kept at tile natural border between areola and breast skin. Reconstruction of the nipple-areola complex further helps to ca mouflage the incision line. This mag result in the best possible aesth etic outcome after mastectomy to date. The technique has been used in 17 breast cancer patients (intraductal cancer, n = 5; T1/T2 ductal can cer, n = 13) with good to excellent results. No local or distant recur rences have been seen; however, mean follow-up time is short (10 month s). As die procedure of choice, a free TRAM flap sas performed in nine patients for immediate reconstruction. The other eight patients were too slim for an autologous reconstruction; therefore, a latissimus dor si muscle flap with a small skin island and a silicone implant were us ed. There were no major complications in either group. In contrast to traditional skin-sparing mastectomy, all bl-east skill is presented wi th tile periareolar approach. Therefore, special surgical expertise is required to ensure tumor free margins, especially with respect to the skin overlying the tumor. If these requirements are met, excellent re sults in breast reconstruction are amenable with adequate oncologic sa fety.