PURPOSE: Breast reconstruction after a mastectomy is being performed using a tissue expander or a TRAM flap. However, a conventional mastectomy leaves a long linear scar after reconstruction. A skin-sparing mastectomy (SSM) with immediate TRAM flap and one-stage star flap nipple-areolar complex reconstruction makes minimal scar tissue and is becoming virtually imperceptible. The purpose of this study is to identify the clinical indications, to evaluate the clinical results, and to encourage the application of this method for the indicated patients.
Meterial and Method: From Apr. 1996 to Mar. 1999, there were 1,027 breast-cancer surgeries. Among them, there were 61 reconstruction cases and a skin-sparing mastectomy (SSM) with immediate reconstruction was performed on 29 cases. Of these patients, 15 underwent SSM and TRAM flap and one-stage star flap nipple-areolar complex reconstruction.
Our selection criteria of SSM were as follows; diffuse DCIS that is not candidates for breast conserving surgery, Paget's disease of the nipple, clinically early breast cancer without skin involvement, and the centrally located cancer that would require removal of the nipple-areolar complex.
RESULTS: All of the TRAM flap and star flap were alive. The cosmetic results were fairly acceptable to the patients. The main drawback was bleeding and wound seroma which was managed by conservative management.
CONCLUSION: Skin-sparing mastectomy with immediate TRAM and star flap reconstruction gives markedly improved results by reducing the scars on the reconstructed breast, providing a supple breast with a natural ptotic shape, and aesthetically satisfied.
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