title: Skin-sparing mastectomy and immediate reconstruction with DIEP flap after breast-conserving therapy.
abstract: BACKGROUND
  Currently about 70% of women who suffer from breast cancer undergo breast-conserving therapy (BCT) without removing the entire breast. Thus, this surgical approach is the standard therapy for primary breast cancer. If corrections are necessary, the breast surgeon is faced with irritated skin and higher risks of complications in wound healing. After radiation, an implant-based reconstruction is only recommended in selected cases. Correction of a poor BCT outcome is often only solved with an additional extended operation using autologous reconstruction.
  
  
  METHODS
  In our plastic surgery unit, which focuses on breast reconstruction, we offer a skin-sparing or subcutaneous mastectomy, followed by primary breast reconstruction based on free autologous tissue transfer to correct poor BCT outcomes. Between July 2004 and May 2011 we performed 1068 deep inferior epigastric artery perforator (DIEP) flaps for breast reconstruction, including 64 skin-sparing or subcutaneous mastectomies, followed by primary DIEP breast reconstruction procedures after BCT procedures.
  
  
  RESULTS
  In all free flap-based breast reconstruction procedures, we had a total flap loss in 0.8% (9 cases). Within the group of patients after BCT, we performed 41 DIEP flaps and 23 ms-2 TRAM flaps after skin-sparing or subcutaneous mastectomies to reconstruct the breast. Among this group we had of a total flap loss in 1.6% (1 case).
  
  
  CONCLUSIONS
  In cases of large tumour sizes and/or difficult tumour locations, the initial oncologic breast surgeon should inform the patients of a possibly poor cosmetic result after BCT and radiation. In our opinion a skin-sparing mastectomy with primary breast reconstruction should be discussed as a valid alternative.
authors.affiliation: Department of Plastic and Aesthetic Surgery, Interdisciplinary Breast Centre, Sana-Kliniken Düsseldorf, Gerresheim Hospital, Düsseldorf, Germany. christoph.andree@sana.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Andree
authors.forename: Beatrix I
authors.initials: BI
authors.lastname: Munder
authors.forename: Katrin
authors.initials: K
authors.lastname: Seidenstuecker
authors.forename: Philipp
authors.initials: P
authors.lastname: Richrath
authors.forename: Philipp
authors.initials: P
authors.lastname: Behrendt
authors.forename: Tobias
authors.initials: T
authors.lastname: Köppe
authors.forename: Mazen
authors.initials: M
authors.lastname: Hagouan
authors.forename: Werner
authors.initials: W
authors.lastname: Audretsch
authors.forename: Carolin
authors.initials: C
authors.lastname: Nestle-Kraemling
authors.forename: Christian
authors.initials: C
authors.lastname: Witzel
mesh_terms: D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods*; D061525:Perforator Flap; D012867:Skin / Q000473:pathology*