title: Optimizing the nipple-areola sparing mastectomy with double concentric periareolar incision and biodimensional expander-implant reconstruction: aesthetic and technical refinements.
abstract: Although the biodimensional anatomical expander-implant system (BEIS) is a reliable technique, little information has been available regarding outcome following nipple-areola sparing mastectomy (NSM). To perform the resection of glandular tissue, while improving the surgical access and maintaining the nipple-areola vascularization we have developed a new approach for NSM based on the double concentric periareolar incision (DCPI). The purpose of this study is to analyze the feasibility, surgical planning and its outcome following NSM. 18 patients underwent NSM reconstructions. Mean time of follow-up was 29 months. The technique was indicated in patients with small/moderate volume breasts. Flap complications were evaluated and information on aesthetic results and patient satisfaction were collected. 83.3% had tumors measuring 2cm or less (T1) and 72.1% were stage 0 and I. All patients presented peripherally tumors located (at least 5cm from the nipple). Skin complications occurred in 11.1%. One patient (5.5%) presented small skin necrosis and a wound dehiscence was observed in one patient (5.5%). The aesthetic result was good/very good in 94.4 percent and the majority of patients were very satisfied/satisfied. No local recurrences were observed. All complications except one were treated by a conservative approach. DCPI-BEIS is a simple and reliable technique for NSM reconstruction. The success depends on patient selection, coordinated planning with the oncologic surgeon and careful intra-operative and post-operative management.
authors: Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine, São Paulo, Brazil; Mastology Department, Hospital Sírio-Libanês São Paulo, São Paulo, Brazil. munhozalex@uol.com.br
authors: Alexandre Mendonça
authors: AM
authors: Munhoz
authors: Claudia
authors: C
authors: Aldrighi
authors: Eduardo
authors: E
authors: Montag
authors: Eduardo
authors: E
authors: Arruda
authors: José Mendes
authors: JM
authors: Aldrighi
authors: José Roberto
authors: JR
authors: Filassi
authors: Marcos
authors: M
authors: Ricci
authors: Jose Augusto
authors: JA
authors: Brasil
authors: Valdemir
authors: V
authors: Rezende
authors: Marcus Castro
authors: MC
authors: Ferreira
mesh_terms: D000328:Adult; D019928:Breast Implantation; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery; D015626:Tissue Expansion; D016896:Treatment Outcome