title: Aesthetic design of skin-sparing mastectomy incisions for immediate autologous tissue breast reconstruction in asian women.
abstract: BACKGROUND
  The advent of skin-sparing mastectomy has allowed for the reconstruction of the breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC) in Asian patients is more pigmented and scars easily. Therefore, commonly described incisions tend to result in poor aesthetic outcomes in Asian patients with breast cancer.
  
  
  METHODS
  We describe an algorithmic approach to skin-sparing mastectomy incisions in Asian patients on the basis of the location of the biopsy scar and the tumor site and size. Four incision types are described: peri-areolar, a peri-areolar incision with a second distant skin paddle, "racquet handle," and peri-areolar with adjacent skin excision.
  
  
  RESULTS
  281 immediate breast reconstructions were performed between May 2001 and February 2012 after skin-sparing mastectomy. The mastectomy incisions used included the peri-areolar design (n=124, 44%), peri-areolar design with a second distant skin paddle (n=39, 14%), "racquet handle" (n=21, 7.5%), and peri-areolar design with adjacent skin excision (n=42, 14%). The traditional elliptical incision and other variants where the NAC outline was not preserved were performed in the remaining 55 patients. The average follow-up was 44.7 months during which there was 1 case of total flap loss and 7 cases of partial flap necrosis; all remaining flaps survived. 24% of the patients (68/281) underwent subsequent nipple reconstruction.
  
  
  CONCLUSIONS
  Our algorithm avoids breast incisions that are randomly placed or excessively long and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparing mastectomy and immediate breast reconstruction to be performed with a consistently achievable aesthetic result in Asian women without neglecting oncological safety.
authors: Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
authors: Bien-Keem
authors: BK
authors: Tan
authors: Division of Plastic Surgery, Department of Surgery, University of Miami, Miami, FL, USA.
authors: Harvey
authors: H
authors: Chim
authors: Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
authors: Zhi Yang
authors: ZY
authors: Ng
authors: Department of Surgical Oncology, National Cancer Centre, Singapore.
authors: Kong Wee
authors: KW
authors: Ong
keywords: Asia; Breast; Esthetics; Mammaplasty; Mastectomy