AESTHETIC REFINEMENT IN BREAST RECONSTRUCTION - COMPLETE SKIN-SPARINGMASTECTOMY WITH AUTOGENOUS TISSUE TRANSFER

Aesthetic results in breast reconstruction are often compromised eithe r by prominent scars or by the presence of an island of skill that dif fers in color and texture from the native breast skin. Complete skin-s paring mastectomy is a technique by which breast scars call be largely eliminated and the need for a visible skin island avoided. A circumar eolar incision is used for mastectomy with a separate axillary incisio n if needed. Autogenous tissue is used to fill the skin envelope, and a disk of skin tempo rarily replaces the areola. Twenty-eight patients treated by this method were reviewed retrospectively. Prerequisites i ncluded a favorable biopsy scar location and a suitable tissue donor s ite. The mean patient age was 42.5 years, and the majority were recons tructed with TRAM flaps (92 percent). There was no evidence of increas ed morbidity or any instance of local recurrence during a follow-up pe riod, which averaged 25.7 months. Aesthetic results were judged excell ent in 12 patients, good in 11 patients, and fair in 5 patients. Insuf ficient tissue volume, shape asymmetry, and areolar position asymmetry were the most common factors that detracted from the quality of the r esults. Advantages of this method, besides the prospect of an ideal ae sthetic result, include easier flap inserting and simplified subsequen t revision procedures. Disadvantages include the requirement of a skil led ablative surgeon and incompatibility with conventional expander/im plant methods of reconstruction.