J E Hunter1, C M Malata. 1. Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 186, Hills Road, Cambridge CB2 2QQ, UK.
Abstract
BACKGROUND: Skin-sparing mastectomy (SSM) is a well-established technique for immediate breast reconstruction (IBR). When used for large and/or ptotic breasts, traditional SSM patterns produce long skin flaps prone to necrosis or 'T' junction breakdown. The authors have previously demonstrated the applicability of the LeJour-type vertical mammaplasty skin pattern to this group of patients. With further experience, indications for this procedure have been widened and the technique refined. RESULTS: Over five years, 26 immediate breast reconstructions were carried out in 19 patients using this technique: three expandable implants, seven LDs, three pedicled TRAMs, five free TRAMs, seven DIEPs and one SIEA flap. Fourteen patients (74%) had simultaneous contralateral balancing LeJour breast reductions or mastopexies. The remaining five patients had bilateral mastectomies and reconstructions using the vertical mammaplasty skin pattern for both breasts. All flaps were successful, but there were three cases of minor skin flap necrosis, three of delayed wound healing and two instances of significant post-operative bleeding. Cosmesis was suboptimal in the prosthetic reconstruction group, necessitating revisional surgery. DISCUSSION AND CONCLUSIONS: The vertical mammaplasty skin pattern was successfully used with a wide range of reconstructions. However, to avoid suboptimal cosmetic results and minimise wound healing problems this technique is not recommended in heavy smokers, very obese patients, those undergoing prosthetic reconstructions or neoadjuvant chemotherapy. The skin resection pattern should also be conservative. The LeJour-type vertical mammaplasty pattern is a viable alternative technique for SSM in selected patients, especially those requiring contralateral balancing surgery and undergoing autologous tissue reconstruction.
BACKGROUND: Skin-sparing mastectomy (SSM) is a well-established technique for immediate breast reconstruction (IBR). When used for large and/or ptotic breasts, traditional SSM patterns produce long skin flaps prone to necrosis or 'T' junction breakdown. The authors have previously demonstrated the applicability of the LeJour-type vertical mammaplasty skin pattern to this group of patients. With further experience, indications for this procedure have been widened and the technique refined. RESULTS: Over five years, 26 immediate breast reconstructions were carried out in 19 patients using this technique: three expandable implants, seven LDs, three pedicled TRAMs, five free TRAMs, seven DIEPs and one SIEA flap. Fourteen patients (74%) had simultaneous contralateral balancing LeJour breast reductions or mastopexies. The remaining five patients had bilateral mastectomies and reconstructions using the vertical mammaplasty skin pattern for both breasts. All flaps were successful, but there were three cases of minor skin flap necrosis, three of delayed wound healing and two instances of significant post-operative bleeding. Cosmesis was suboptimal in the prosthetic reconstruction group, necessitating revisional surgery. DISCUSSION AND CONCLUSIONS: The vertical mammaplasty skin pattern was successfully used with a wide range of reconstructions. However, to avoid suboptimal cosmetic results and minimise wound healing problems this technique is not recommended in heavy smokers, very obesepatients, those undergoing prosthetic reconstructions or neoadjuvant chemotherapy. The skin resection pattern should also be conservative. The LeJour-type vertical mammaplasty pattern is a viable alternative technique for SSM in selected patients, especially those requiring contralateral balancing surgery and undergoing autologous tissue reconstruction.