@article{3029886,
    title = "De-epithelialized Skin Flaps to Minimize Complications in Large Breast
Reconstruction A Tailored Approach",
    author = "Lanitis, Sophocles and Kontos, Michalis and Chortis, Panagiotis and and Gkanis, Vasilios and Peristeraki, Styliani and Lainas, Spyridon and and Hadjiminas, Dimitri J.",
    journal = "Annals of Plastic Surgery",
    year = "2021",
    volume = "87",
    number = "1",
    pages = "16-23",
    publisher = "Lippincott, Williams & Wilkins",
    issn = "0148-7043, 1536-3708",
    doi = "10.1097/SAP.0000000000002768",
    keywords = "skin-reducing mastectomy; breast cancer; skin-sparing mastectomy; breast
reconstruction",
    abstract = "Mastectomy and immediate reconstruction may be challenging in patients
with large breasts, especially when significant ptosis is also present.
Skin-reducing mastectomy (SRM) is usually indicated in these cases,
although with increased morbidity. The aims of the study were to
introduce 2 modifications of the classic technique and to incorporate
them in the management algorithm to improve the outcomes. Twenty
patients fulfilling the criteria for SRM underwent mastectomy and
reconstruction either with the “classic SRM” (8 patients) or with 1
of the 2 modifications described here: modification A “vertical limb
bridging” (for patients with very large breasts, 2 patients) and
modification B “dual coverage” (for patients with moderate breasts,
10 patients). All reconstructions were performed using a slow
progressive expansion of the implant. Herein, we describe the techniques
along with the proposed indications for each one of them. There was no
reconstruction failure, and all patients were satisfied with the final
results. There were 2 cases with T junction, lateral skin flap partial
ischemia managed with delayed revision of the wound on the fifth
postoperative day to allow less skin excision. One patient (smoker)
developed severe lower pole cellulitis, which was managed
conservatively. Finally, 1 patient who underwent radiotherapy developed
a late infected seroma, which was managed successfully with drainage and
antibiotics. Overall, there was good lower pole projection even with the
dual-coverage modification. Skin-reducing mastectomy can be tailored
according to individual patient anatomy, and the high reported
complication rate associated with this technique can be minimized using
certain surgical modifications, tissue expanders with progressive
inflation, and good patient selection."
}