title: Skin-reducing mastectomy and one-stage implant reconstruction with a myodermal flap: a safe and effective technique in risk-reducing and therapeutic mastectomy.
abstract: BACKGROUND
  Immediate reconstruction following mastectomy for breast cancer has been shown to be oncologically safe and associated with improved psychosocial outcomes for patients. Bostwick described a technique for one-stage implant based reconstruction, combining skin-sparing mastectomy with concurrent reduction of the skin envelope. This report reviews the experience of a single centre using skin-reducing mastectomy and one-stage implant reconstruction in both early stage breast cancer and risk-reducing mastectomy, with specific reference to frequency of complications, implant loss and oncological outcomes.
  
  
  RESULTS
  A retrospective review was undertaken to identify women who had undergone skin-reducing mastectomy and one-stage implant reconstruction using a de-epithelialised dermal flap, between October 2008 and October 2012. One hundred and four consecutive mastectomies, with reconstruction, were performed by two surgeons on 64 patients. No complications were seen in 43.8% of patients. At three months, four implants were lost (3.8% of breast reconstructions, 6.3% of patients), due to either peri-implant infection or mastectomy skin flap necrosis. One patient required unplanned return to theatre for evacuation of a haematoma. Minor mastectomy skin flap necrosis was seen in 10 breasts (9.6% of reconstructed breasts) and superficial wound infection in 8 breasts (7.7% of reconstructed breasts). All of these complications were managed conservatively and none required operative intervention. At a median follow up of 35 months (4-53 months) there had been one episode of ipsilateral axillary nodal recurrence.
  
  
  CONCLUSIONS
  One-stage implant reconstruction using a myo-dermal flap technique following skin-reducing mastectomy is safe and should be considered in selected patients. Most complications are minor and will resolve with conservative management. Major complications such as implant failure or immediate reoperation, were relatively uncommon (6.3% patients, 3.8% of reconstructed breasts). Early follow-up suggests that oncological outcomes are satisfactory, but longer follow-up is required to substantiate this.
authors.affiliation: Breast Surgery Unit, Belfast Health and Social Care Trust, Belfast City Hospital, Level 2, 51 Lisburn Road, Belfast BT9 7AB, United Kingdom.
authors.forename: G W
authors.initials: GW
authors.lastname: Irwin
authors.forename: A
authors.initials: A
authors.lastname: Black
authors.forename: S E
authors.initials: SE
authors.lastname: Refsum
authors.forename: S A
authors.initials: SA
authors.lastname: McIntosh
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery / Q000637:transplantation; D061214:Patient Safety; D011183:Postoperative Complications / Q000503:physiopathology; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D006113:United Kingdom; D014945:Wound Healing / Q000502:physiology*
keywords: Breast implant; Breast reconstruction; Inferior dermal flap; Myo-dermal flap; One stage implant reconstruction