title: Skin-reducing mastectomy and immediate breast reconstruction in patients with macromastia.
abstract: BACKGROUND
  In women with macromastia, a type IV skin sparing mastectomy is often required to achieve an aesthetically pleasing reconstruction. The introduction of "skin-reducing mastectomy", which inserts a permanent prosthetic device into a large pouch made by the pectoralis major muscle and an inferior pedicle dermal flap, allows the surgeon to achieve a safe oncologic result plus a cosmetically satisfying reconstruction.
  
  
  OBJECTIVE
  We report here our experience with the skin-reducing mastectomy with the aim of emphasizing the problems associated with the technique.
  
  
  METHODS
  A study was conduced from April 2009 to November 2012, 74 patients with breast cancer were selected then received a skin-reducing mastectomy. The enrolled women satisfied the criteria of Nava. Statistical analysis was conduced to estimate the significance of the outcome results and complication rate.
  
  
  RESULTS
  A total of 88 SRMs were performed and the outcomes were as follows: excellent in 34 patients, good in 21, and poor in 8. We recorded 25 % of adverse events and statistic helped us to identify patient related factors whose can increase the complications onset.
  
  
  CONCLUSIONS
  Skin-reducing mastectomy is an indispensable procedure to treat cancer in large and pendulous breasts. The correct patient selection is mandatory to reduce the not negligible complication risk. Skin reducing mastectomy when is well conduced allow to obtain good results with patient satisfaction but, like other breast-conserving surgeries, in some case is not the ultimate solution, because it may require some revisions to maintain the optimum results. To day it be consider relatively safe in selected patient and the gold standard in macormastia immediate reconstruction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy. roydevita@ifo.it.
authors.forename: Roy
authors.initials: R
authors.lastname: De Vita
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy. mpozzi@ifo.it.
authors.forename: Marcello
authors.initials: M
authors.lastname: Pozzi
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy. zoccali.giovanni@virgilio.it.|Department of Life, Health and Environmental Sciences, Plastic Reconstructive and Aesthetic Surgery Section, L'Aquila University, L'Aquila, Italy. zoccali.giovanni@virgilio.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zoccali
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy. mauriziocostantini@ifo.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Costantini
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy. ppgullo@libero.it.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Gullo
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy. buccheriernesto@libero.it.
authors.forename: Ernesto Maria
authors.initials: EM
authors.lastname: Buccheri
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy. varanese@ifo.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Varanese
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery*; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000601:surgery