IMMEDIATE RECONSTRUCTION AFTER COMPLETE SKIN-SPARING MASTECTOMY WITH AUTOLOGOUS TISSUE

Background: Immediate breast reconstruction with autologous tissue can re-create a breast mound that closely resembles the native breast in shape and consistency. Results are limited by scarring and color diffe rences between flap and native breast skin. This study reviews all pat ients undergoing complete skin-sparing mastectomy with immediate autol ogous tissue reconstruction over the past 4 years. Study Design: Twent y-eight patients with a mean age of 43 years (range, 32-53 years) were retrospectively reviewed. Requirements for the complete skin-sparing approach included a favorable biopsy scar location, adequate areolar d iameter, and suitable donor site for autologous tissue reconstruction. Ninety-two percent of patients were reconstructed with a transverse r ectus abdominis musculocutaneous flap. Results: There were no instance s of flap loss or local recurrence during the followup period (mean, 2 7 months; range, 14-48 months). Complications at the reconstruction si te were minor and limited to cellulitis, periareolar skin loss, and th e need for repeat skin excision because of a very close pathologic mar gin. Donor site complications were seen in five patients. Aesthetic re sults were judged as excellent or good in 75% of patients. Conclusions : Complete skin-sparing mastectomy with immediate autologous tissue re construction has enhanced immediate breast reconstruction by reducing scar burden and eliminating color differences without an increased inc idence of local recurrence. This procedure is limited by appropriate p atient selection and technical expertise in performing the mastectomy. (J Am Cell Surg 1998;187:17-21. (C) 1998 by the American College of S urgeons).