From August 1997 to April 2001, we performed 267 immediate breast reconstructions, 165 of which were completed. Oncologic surgeons performed mastectomies. As many of them do not accept the concept of the traditional skin-sparing mastectomy (in which a separate skin excision is performed in peripheral locations of the cancer), we have used a skin-sparing mastectomy according to the Madden model (where the skin overlying cancer must be removed in continuity with the nipple–areola complex), but with different patterns of skin incisions. In central or paracentral cancer, we performed a circular incision, with a maximum diameter of 12 cm, that included the nipple–areola complex, the skin over the lump and the axillary dissection when needed. In peripheral cancer locations, we performed a drop-shaped incision to include in continuity the skin over the lump. The skin wound was closed with a simple purse string in circular incisions. In drop-shaped incisions, a purse string was performed in the central third of the wound; the lateral two-thirds were closed with an intradermal suture. The semilunar expander was created to obtain better projection and ptosis than those achieved by other expanders. Actual follow-up ranged from 1 to 36 months, with a mean of 24 for a total of 165 completed reconstructions. Major complications occurred in 13 patients (5.6%) that required expander removal; only one definitive implant required removal. Contralateral reshaping was performed on 37 patients (22%).
European Journal of Plastic Surgery – Springer Journals
Published: Jan 1, 2002
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