Background: The inverted-T skin-reducing mastectomy with implant reconstruction represents a very effective reconstructive and cosmetic option in patients with macromastia. However, in this subset of patients, the risk of skin flap necrosis, especially at the T-junction, is significant. In this setting, complete implant coverage with viable tissue beneath the mastectomy skin flaps is essential to reduce morbidity. In this article, the authors retrospectively review their series of 16 skin-reducing mastectomy and immediate one-stage implant reconstructions using the submuscular-subfascial pocket, analyzing the reconstructive issues and cosmetic outcomes.
Methods: Between June of 2008 and August of 2010, 14 women underwent skin-reducing mastectomy with immediate implant reconstruction using definitive anatomical gel implants, totalling 16 breasts. Reconstructive evaluation methods were clinically and photography-based assessment. The BREAST-Q was used to quantify patient satisfaction.
Results: The average follow-up time was 18.6 months (range, 6 to 36 months). The average implant volume was 416.5 cc (range, 300 to 500 cc). The reconstructive outcomes were excellent to good, with patient satisfaction ranking high to very high, except in two patients who experienced skin necrosis (14.3 percent).
Conclusions: The authors' series suggests that skin-reducing mastectomy with immediate implant reconstruction can be easily and safely performed when an appropriate conservative skin-reducing mastectomy pattern is designed, providing complete autologous implant coverage with the submuscular-subfascial pocket. However, further studies are needed to enhance patient selection and reduce the complication rate.
Clinical question/level of evidence: Therapeutic, IV.