Long-Term Outcomes after Primary Breast Reconstruction Using a Vertical Skin Pattern for Skin-Sparing Mastectomy

Abstract

Preservation of the breast skin envelope in skin-sparing mastectomy is the key component for superior aesthetic results. Breast mound disproportions in primary breast reconstruction caused by a mismatch between retained skin envelope and donor-tissue volume provokes breast shape asymmetries. A skin-sparing mastectomy using a vertical pattern can address these breast mound imperfections by adjusting this mismatch in a vertical direction. A retrospective chart review was conducted over a 10-year period for patients who underwent skin-sparing mastectomy using a vertical pattern for malignant, premalignant, benign, and deformational disease of the breast. Reconstruction was performed primarily with free muscle-sparing transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flaps. Seventy-two patients, aged 31 to 69 years (mean, 51.5 years), underwent 106 skin-sparing mastectomies using a vertical pattern and primary reconstruction with 38 unilateral and 34 bilateral free flaps (muscle-sparing transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flaps). The mean follow-up period was 42 months, without any local or systemic recurrences of the breast cancer. The complication rates of 8.49 percent at the donor site and 6.60 percent at the flap site show a direct correlation to smoking but no correlation to body mass index, cancer stage, or diabetes. Skin-sparing mastectomy using a vertical pattern improves the aesthetic outcome in primary breast reconstruction without compromising oncologic safety and demonstrates low morbidity. Elimination of the disharmony between skin flap and breast volume in the vertical direction while respecting the inframammary crease produces a youthful, symmetrical conical breast shape with medial fullness.