Summary
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.
Keywords
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Article info
Publication history
Published online: October 04, 2006
Accepted:
April 23,
2006
Received:
February 9,
2006
Footnotes
☆Presented at Summer Meeting, British Association of Plastic Surgeons, Dublin, Ireland, 7th July 2004 and at the 40th Congress of the European Society for Surgical Research, Konya, Turkey, 27th May 2005.
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
