Skin-Reducing Subcutaneous Mastectomy Using a Dermal Barrier Flap and Immediate Breast Reconstruction with an Implant: A New Surgical Design for Reconstruction of Early-Stage Breast Cancer

Abstract

The development of skin-sparing mastectomy techniques for early-stage breast cancer has opened a new era in reconstructive breast surgery. Because of improved early diagnoses, the demand for skin-sparing techniques continues to increase more than ever. Between March 2006 and April 2008, skin-reducing subcutaneous mastectomy (SRSM) using the dermal barrier flap technique and simultaneous breast reconstruction with silicone implants was performed for 15 patients (a total of 26 breasts) who had either a diagnosis of early-stage breast cancer or indications for prophylactic mastectomy. Of the 15 patients, 11 underwent bilateral reconstruction. The remaining four patients underwent unilateral reconstruction using SRSM with the dermal barrier flap technique. The average age of the patients who underwent SRSM with the dermal barrier flap was 45.7 years. All the patients were discharged from the hospital on postoperative day 1. The mean follow-up period was 12 months, and the recovery time was 35 days. Excellent aesthetic results and uneventful healing were obtained for 23 breasts. Partial nipple-areola necrosis occurred in two breasts. Total skin necrosis in the bilateral nipple-areola and central breast region occurred for one patient who underwent bilateral SRSM. Prosthesis exposure was not observed for any of these patients. The authors present their early results with SRSM using the dermal barrier flap and silicone implants for early-stage breast cancer. The dermal barrier flap became a reliable procedure by providing a decreased breast envelope, eliminating the risk of implant exposure, and forming a double layer of dermal tissue at the incision line.