Skin Sparing Mastectomy with Circumareolar Incision and Immediate TRAM and One-Stage Star Flap Nipple-Areolar Complex Reconstruction

Ahn, Sei Hyun; Lee, Pyong Chan; Son, Byung Ho; Han, Sang Hoon

Abstract

BACKGROUND: Breast reconstruction after a mastectomy is being performed in many cases by using a tissue expander or a TRAM flap. However, a conventional mastectomy leaves long linear scar formation on the breast skin after reconstruction. A skin-sparing mastectomy (SSM) with one-stage star flap nipple-areolar complex immediate reconstruction makes minimal scar tissue, and with a circumferential incision is made around the nipple, becoming virtually imperceptible. The purpose of this study is to identify the clinical indications, to evaluate the clinical results, and to encourage the application of thins method for the indicated patients.
MATERIALS AND METHODS
During the recent 3 years, 1996 through 1999, there were 1027 breast-cancer surgeries. Among them, there were 61 reconstruction cases, a skin-sparing mastectomy (SSM) with immediate reconstruction was performed on 29 cases. Of these patients, 15 patients were taken SSM and TRAM flap reconstruction. Our patients selection criteria of SSM was as follows, diffuse DCIS that not candidates for breast conserving surgery, Paget's disease of the nipple, clinically early breast cancer without skin involvement, and the centrally located cancer that would require removal of the nipple-areolar complex.
RESULTS
All the surgeries performed under these procedures were considered to be successful. All of the TRAM flap and star flap were alive. The main rawback was bleeding, which occurred in 6 patients but was managed by transfusion. The wound seroma occurred in 3 patients and was managed easily by repeated aspiration.
CONCLUSIONS
Skin-sparing mastectomy with immediate TRAM and star flap reconstruction gives markedly improved results by reducing the scars on the reconstructed breast, providing a supple breast with a natural ptotic shape, and aesthetically satisfied. We propose more frequent application of this method for the indicated patients, but we need further follow-up of the local recurrence rate and the detection rate in these patients.