title: Envelope mastectomy with immediate reconstruction (EMIR).
abstract: OBJECTIVE
  To develop an oncologically safe and aesthetically acceptable technique for mastectomy, using a muscle flap and tissue expander through one incision.
  
  
  METHODS
  Twelve consecutive patients (mean age 40) underwent an envelope mastectomy (skin and nipple sparing), with immediate reconstruction with a latissimus dorsi muscle flap and tissue expander. Assessment of cosmesis was by review of pre- and post-operative photographs by an independent observer.
  
  
  RESULTS
  During follow-up there have been no recurrences. Assessment of cosmesis gave a score of 44 out of 48 (92%). One prosthesis was removed due to erosion of the prosthesis through the skin.
  
  
  CONCLUSIONS
  In patients with large lesions, multi-focal lesions (both invasive and in situ) and recurrent phyllodes tumours may undergo an oncologically safe mastectomy with immediate reconstruction through a single incision that is inconspicuous being in the mid-axillary line. Although follow up is only 8.5 months, long-term studies are being undertaken.
authors.affiliation: The Breast Unit, Basildon Hospital, Nethermayne, Basildon, SS16 5NL, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Sufi
authors.forename: M
authors.initials: M
authors.lastname: Gittos
authors.forename: D S
authors.initials: DS
authors.lastname: Collier
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D013524:Surgical Flaps; D013997:Time Factors; D015625:Tissue Expansion Devices; D016896:Treatment Outcome