Abstract
Skin-sparing mastectomy offers many advantages to the patient who is undergoing mastectomy with immediate breast reconstruction. Breast skin that is not involved with tumor is preserved for use in the reconstruction, not only providing coverage but also helping to correctly shape and position the breast. Visible scarring and skin replacement are reduced, improving the cosmetic outcome. Subcutaneous fat preservation also reduces the amount of tissue required for adequate breast mound reconstruction, a factor that can be important in thin patients who are undergoing bilateral reconstruction with TRAM flaps. The free TRAM flap, with splitting and partial preservation of the muscle, is my preferred technique of reconstruction for most patients because it combines well-vascularized autologous tissue with acceptable (and minimal) donor site morbidity. For patients who do not need more than 65% of the TRAM flap to reconstruct an adequate breast mound, however, the DIEP flap can be a good alternative.
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