title: The aesthetic mastectomy utilizing a non-nipple-sparing portal approach.
abstract: The Box-To-X incision and closure is a novel technique for a skin-sparing mastectomy with immediate prosthetic reconstruction. The Box-To-X portal creates a 27% larger access for dissection as compared with a standard periareolar incision, while containing the entire scar within the limits of the original areola. Following nipple-areolar reconstruction and tattooing, a virtually scarless mastectomy results. Over a 54-month period, 159 skin-sparing mastectomies with immediate prosthetic reconstruction using the Box-To-X portal were performed on 98 patients. Allograft slings were used in all patients. Successful reconstruction was achieved in 93 of 98 patients (93%). Complications were observed in 23 (23%) patients. The most common complications were wound dehiscence, seroma, full-thickness necrosis along the edges of the "X," and wound infection. Removal of the implant was required in 5 patients as a result of persistent infection (5%). The low complication rate, adherence to accepted oncologic principles, and minimal scarring indicate that this technique is a sound addition to the armamentarium of both the breast oncologic surgeon and the reconstructive surgeon.
authors: Breast Surgery Division, The Breast Institute at Northern Westchester Hospital, Mt. Kisco, NY, USA. acahan@nwhc.net
authors: Anthony C
authors: AC
authors: Cahan
authors: David A
authors: DA
authors: Palaia
authors: Michael
authors: M
authors: Rosenberg
authors: Philip C
authors: PC
authors: Bonanno
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*