Τίτλος:
De-epithelialized Skin Flaps to Minimize Complications in Large Breast
Reconstruction A Tailored Approach
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Lanitis, Sophocles
Kontos, Michalis
Chortis, Panagiotis and
Gkanis, Vasilios
Peristeraki, Styliani
Lainas, Spyridon and
Hadjiminas, Dimitri J.
Περιοδικό:
Annals of Plastic Surgery
Εκδότης:
Lippincott, Williams & Wilkins
Λέξεις-κλειδιά:
skin-reducing mastectomy; breast cancer; skin-sparing mastectomy; breast
reconstruction
DOI:
10.1097/SAP.0000000000002768
