Skin-Reducing Mastectomy in Immediate Reconstruction: How to Limit Complications and Failures.
BACKGROUND
In hypertrophic and/or very ptotic breasts, skin-reducing mastectomy (SRM) is challenging and the risk of complications is high. Few publications have reported the use of an autologous latissimus dorsi flap (ALDF) in this indication. Most studies opt for implant reconstructions, with a high failure rate.


OBJECTIVE
We aimed to identify and present the technical refinements that reduce the risk of reconstruction failure in patients with hypertrophic and/or ptotic breasts with breast cancer or at risk of breast cancer after SRM with immediate breast reconstruction (IBR) utilizing an ALDF.


METHODS
Our retrospective study, covering a period of 18 years, included a series of 60 patients with hypertrophic and/or ptotic breasts who underwent 67 SRM and IBR procedures utilizing an ALDF. The complications were recorded and the risk factors analyzed.


RESULTS
Sixty-seven SRMs were reviewed. Forty-nine procedures were performed with an inverted-T scar technique and 18 with a vertical scar technique. The nipple-areola complex (NAC) was preserved in 10 cases. There were eight (11.9%) cases of minor mastectomy flap necrosis after skin-reducing reconstructions, 16 (23.8%) wound dehiscences, no infections, no breast seromas, and no reconstruction failures. Smoking increased the risk of minor mastectomy flap necrosis (P = 0.048) and wound dehiscence (P = 0.002). Previous radiotherapy was associated with minor mastectomy flap necrosis (P = 0.001).


CONCLUSIONS
The use of an ALDF together with technical refinements that preserve the vascular supply of the skin envelope leads to successful IBR with consistently good aesthetic results. Above all, it avoids failure of the reconstruction in very large or ptotic breasts.


METHODS
From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France.
Lolita
L
Pechevy
From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France.
Raphael
R
Carloni
From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France.
Samia
S
Guerid
From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France.
Pierre-Luc
PL
Vincent
From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France.
Gilles
G
Toussoun
From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France.
Emmanuel
E
Delay
D000328:Adult; D001940:Breast / Q000473:pathology / Q000601:surgery*; D001941:Breast Diseases / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006984:Hypertrophy; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D009336:Necrosis; D010781:Photography; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000098:blood supply* / Q000473:pathology; D012907:Smoking / Q000009:adverse effects; D064171:Superficial Back Muscles / Q000601:surgery; D013524:Surgical Flaps / Q000009:adverse effects; D017211:Treatment Failure