title: Skin sparing/skin reducing mastectomy (SSM/SRM) and the concept of oncoplastic breast surgery.
abstract: BACKGROUND
  With the better understanding of breast cancer history and biology, improved diagnostic modalities and the shift towards minimally invasive surgeries, indications for prophylactic mastectomy, skin sparing or skin reducing mastectomies (SSM/SRM) with nipple areolar complex (NAC) preservation coupled with immediate breast reconstruction are gaining popularity. The authors share their experience and conception with mastectomy and immediate alloplastic breast reconstruction with the esthetic circumvertical mammoplasty pattern combined with the dermal barrier buttress flap.
  
  
  METHODS
  The described technique was performed for 28 patients presenting for mastectomy and immediate alloplastic breast reconstruction. With close collaboration between the oncologic and plastic surgeons, mastectomy was performed in all cases with the esthetic circumvertical mammoplasty pattern. To achieve safe excision and optimal reconstruction, the standard incisions could be custom designed to fit oncologic requirements and allow the creation of a dermal barrier flap used as a buttress separating the implant from the suture line.
  
  
  CONCLUSIONS
  The circumvertical mastectomy pattern combined with the dermal barrier buttress flap is a versatile option allowing safe reconstruction regardless of the tumor and necessary skin excision location.
authors.affiliation: Euro-Mediterranean Council for Burns and Fire Disasters, Beirut, Lebanon; Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: batiyeh@terra.net.lb.
authors.forename: Bishara
authors.initials: B
authors.lastname: Atiyeh
authors.affiliation: Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: saaddibo@yahoo.com.
authors.forename: Saad
authors.initials: S
authors.lastname: Dibo
authors.affiliation: Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: dreliaszgheib@gmail.com.
authors.forename: Elias
authors.initials: E
authors.lastname: Zgheib
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Jaber
authors.initials: J
authors.lastname: Abbas
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D010348:Patient Care Team; D013524:Surgical Flaps
keywords: Breast cancer; Breast implant; Breast reconstruction; Dermal barrier; Skin reducing mastectomy; Skin sparing mastectomy