title: Cannula-Assisted Flap Elevation (CAFE): a novel technique for developing flaps during skin-sparing mastectomies.
abstract: BACKGROUND
  One of the most challenging procedures in breast surgery is the skin-sparing mastectomy (SSM). Various techniques and incisions have evolved that characterize this procedure; however, what is common in all of them is the smaller the incision, the more difficult it is to develop the skin flaps.
  
  
  METHODS
  A procedure was developed that incorporates the use of liposuction cannulas (without suction) to create the skin flaps. The technique and results are described in this manuscript.
  
  
  RESULTS
  From October of 2012 to April 2014, 289 mastectomies (171 patients) were performed using the CAFE procedure on women of all shapes and sizes. Postoperatively, no problems were experienced with flap viability using this technique. The main difference in side effects between the CAFE technique and other standard techniques for developing flaps in SSMs was more bruising than normal, but this resolved rapidly. The results for use of this technique were consistently impressive. The learning curve for this procedure is very short, especially for those who perform SSMs using sharp technique (scissors). Residents and fellows became proficient with the CAFE technique in a relatively short amount of time. Plastic surgeons were pleased with the cosmetic outcomes of their reconstructions that follow this type of mastectomy. Patients were extremely satisfied with their reconstructions as well.
  
  
  CONCLUSIONS
  Incorporating the use of liposuction cannulas (without suction) makes the creation of flaps for SSM a relatively simple and rapid method. It is especially useful to assist in developing skin flaps with even the smallest of skin incisions.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA, mandjgrant@sbcglobal.net.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Grant
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery; D057785:Catheters; D005260:Female; D006801:Humans; D059032:Learning Curve; D008408:Mastectomy / Q000379:methods*; D013524:Surgical Flaps