title: Esthetic evaluation of immediate breast reconstruction after nipple-sparing or skin-sparing mastectomy.
abstract: BACKGROUND
  It has been reported that immediate autologous tissue breast reconstruction after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) is esthetically superior to autologous tissue reconstruction after conventional mastectomy (CM). We evaluated reconstructed breasts to determine whether these methods contribute to breast appearance other than skin texture.
  
  
  METHODS
  Between April 1992 and September 2001, forty-two patients underwent immediate breast reconstruction using autologous tissue. Mastectomy options were NSM, SSM and CM. Postoperative photographs were evaluated using a subscale (volume, contour, placement, and inframammary fold) on a 0-2 point scale. Sternal notch to nipple distances of the affected and normal sides were measured with photographs to estimate nipple-areola complex (NAC) position. No corrective procedure was performed in a later phase before evaluation.
  
  
  RESULTS
  NSM was performed in 22, SSM in 6 and CM in 14 cases. On esthetic evaluation, the NSM and SSM groups received 4.96 and the CM group received 4.63. There were no significant differences. In the NSM and SSM group, the NAC position rose in cases with partial necrosis or fat lysis compared with the no complication group (p = 0,004).
  
  
  CONCLUSIONS
  Autologous tissue breast reconstruction after NSM or SSM is esthetically equal to autologous tissue reconstruction after CM with regard to parameters other than skin texture. Preserved or simultaneously reconstructed NAC sometimes emphasizes nipple-areola asymmetry when breast deformity has occurred.
authors.affiliation: Department of Plastic and Reconstractive Surgery, Tokyo Medical and ental University, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Mori
authors.forename: Tadashi
authors.initials: T
authors.lastname: Umeda
authors.forename: Takayuki
authors.initials: T
authors.lastname: Osanai
authors.forename: Yuiro
authors.initials: Y
authors.lastname: Hata
mesh_terms: D000328:Adult; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D062109:Dermatologic Surgical Procedures; D004954:Esthetics; D005260:Female; D006801:Humans; D007249:Inflammation; D008408:Mastectomy / Q000534:rehabilitation*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery; D017060:Patient Satisfaction; D010781:Photography; D019651:Plastic Surgery Procedures; D012867:Skin / Q000033:anatomy & histology; D013524:Surgical Flaps; D013997:Time Factors