One-stage immediate breast and nipple-areolar reconstruction with autologous tissue I: A preliminary report

This preliminary report discusses 7 patients with early breast cancer (mean age, 48 years) who underwent one-stage breast reconstruction. Reconstructi on was achieved using a deepithelialized transverse rectus abdominis muscul ocutaneous (TRAM) flap placed in a pocket created by a skin-sparing mastect omy. Areolar reconstruction is performed by harvesting the areola as a full -thickness graft from the mastectomy specimen, and nipple reconstruction is achieved with a CV flap (in zone II of the TRAM flap), which is deepitheli alized and covered with a full-thickness graft from the areola. In all pati ents a contralateral reduction or mastopexy was performed. Recent evidence suggests that not all patients with early breast cancer have areolar involv ement, and that certain prognostic factors can be used to predict the likel ihood of tumor involvement. A number of large studies have shown that in pa tients with early breast cancer, when the tumor is situated more than 5 cm from the nipple-areolar complex, tumor involvement of the nipple-areolar co mplex is most unlikely. No patients in this study had histological evidence of nipple involvement by cancer. The aesthetic results were very satisfact ory in 5 of 7 patients. One patient who developed sepsis of the TRAM flap h ad an unsatisfactory result. The other complications that occurred were min or and self-limiting, The advantages of single-stage breast reconstruction are financial and psychological. In addition, the patient attains homogenou s nipple-areolar reconstruction. Areolar reconstruction is achieved with th e best possible option-areola, This preliminary report suggests that in a s elect group of patients with early breast cancer, when the tumor is more th an 5 cm from the nipple-areolar complex, the areola may be preserved. The a esthetic results in these patients was considered satisfactory, However, lo ng-term studies are required to confirm the oncological safety of this tech nique.