title: Autologous inferior dermal sling (autoderm) with concomitant skin-envelope reduction mastectomy: an excellent surgical choice for women with macromastia and clinically significant ptosis.
abstract: BACKGROUND
  Skin-sparing mastectomy and prosthetic reconstruction can be complicated by poor surgical outcomes in large-breasted, obese women. This article describes a single surgeon's experience comparing conventional skin-sparing mastectomy (SSM) and skin-reduction mastectomy using an autologous vascularized inferior dermal/cutaneous sling (autoderm).
  
  
  METHODS
  From July 2007 to May 2012, patients undergoing skin-sparing mastectomy were evaluated for surgical outcomes. After July 2009, the surgeon performed skin-reduction mastectomies with autoderm (SRM-AD) on all patients with macromastia or grade 3-4 ptosis. Remaining patients in this time period (SSM-cont) underwent conventional skin-sparing mastectomies while all previous patients (historical) also underwent skin-sparing mastectomies (SSM-hist). A predictive model was used to compare the large historical patients (who would have had reduction mastectomy if available) with the smaller historical patients to evaluate the effect of the procedure.
  
  
  RESULTS
  Body mass index (BMI) and specimen weight were higher in both the SRM group and large historical group. The hazard ratio for having skin-reduction mastectomy was 0.53 (P = 0.51) compared with the historical group. There was a total of 16 complications for the whole study. Smoking was the only significant risk factor.
  
  
  CONCLUSIONS
  This study shows that mastectomy with prosthetic reconstruction using a skin-reduction technique with autoderm can be done safely with a low complication rate and improved cosmetic outcomes in the traditionally "at-risk" group of women with high BMI and large ptotic breasts.
authors.affiliation: Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA. dietzj3@ccf.org
authors.forename: Jill
authors.initials: J
authors.lastname: Dietz
authors.forename: P
authors.initials: P
authors.lastname: Lundgren
authors.forename: A
authors.initials: A
authors.lastname: Veeramani
authors.forename: C
authors.initials: C
authors.lastname: O'Rourke
authors.forename: S
authors.initials: S
authors.lastname: Bernard
authors.forename: R
authors.initials: R
authors.lastname: Djohan
authors.forename: J
authors.initials: J
authors.lastname: Larson
authors.forename: R
authors.initials: R
authors.lastname: Isakov
authors.forename: R
authors.initials: R
authors.lastname: Yetman
mesh_terms: D001940:Breast / Q000002:abnormalities / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002755:Choice Behavior; D062109:Dermatologic Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000601:surgery*; D016462:Mammaplasty; D008408:Mastectomy / Q000534:rehabilitation*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016038:Skin Transplantation; D013524:Surgical Flaps