Research Article| Volume 65, ISSUE 2, P187-194, February 2012

Immediate breast reconstruction using autologous skin graft associated with breast implant

Published:October 03, 2011DOI:



      Immediate breast reconstruction with skin graft is still little mentioned in the literature. Follow-up studies regarding the technique aspects are particularly scarce. The objective was to detail immediate breast reconstruction using autologous skin graft.


      Patients (n = 49) who underwent mastectomies and autologous immediate breast reconstruction with skin graft associated with a breast implant at A. C. Camargo Hospital (São Paulo, Brazil) between January 2007 and July 2010 were included. Information on clinical data, technique details and clinical outcome were prospectively collected. Following mastectomy, the autologous full-thickness skin graft was obtained through an inframammary fold incision along the contralateral breast in most patients. The skin graft was placed on the surface of the pectoralis major muscle after adjustments to conform to the mastectomy defect. A minimum of 10-month follow-up period was established.


      Patients’ age ranged from 35 to 55 years and all received a silicone gel textured surface implant to obtain the necessary breast mound. The mean surgical time was 45 min, and the mean amount of skin resection was 4.5 cm in the largest diameter. Follow-up ranged from 10 to 35 months (median 23). All patients had silicone-gel textured surface implants to perform the breast mound reconstruction. No complications were observed in 87.8% of reconstructions. Forty-six patients (94%) had no complaints about the donor-site aesthetics. The result was a breast mound with a central ellipse of healed skin graft. Three (6%) poor results were observed. Thirty-six patients (67%) reported the results as good or very good.


      Our results lead us to conclude that autologous skin graft provided a reliable option in immediate breast reconstruction to skin-sparing mastectomy defects. The technique accomplished a single-stage implant breast reconstruction when there is inadequate skin coverage.


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        • Bostwick 3rd, J.
        Breast reconstruction-from never to now.
        J Am Coll Surg. 2001; 192: 69-70
        • Kroll S.S.
        Immediate breast reconstruction: a review.
        Ann Chir Gynaecol. 1997; 86: 5-12
        • Gandolfo E.A.
        Breast reconstruction with a lower abdominal myocutaneous flap.
        Br J Plast Surg. 1982; 50: 452-457
        • Hartrampf Jr., C.R.
        • Scheflan M.
        • Black P.
        Breast reconstruction with a transverse abdominal island flap.
        Plast Reconstr Surg. 1982; 98: 216-225
        • Jahkola T.
        • Asko-Seljavaara S.
        • Van Smitten K.
        Immediate breast reconstruction.
        Scand J Surg. 2003; 92: 249-256
        • Kijima Y.
        • Yoshinaka H.
        • Owaki T.
        • Funasako Y.
        • Aikou T.
        Immediate reconstruction using inframammary adipofascial flap of the anterior rectus sheath after partial mastectomy.
        Am J Surg. 2007 Jun; 193: 789-791
        • Spear S.L.
        • Baker Jr., J.L.
        Classification of capsular contracture after prosthetic breast reconstruction.
        Plast Reconstr Surg. 1995; 96: 1119-1123
        • Al-Ghazal S.K.
        • Sully L.
        • Fallowfield L.
        • Blamey R.W.
        The psychological impact of immediate rather than delayed breast reconstruction.
        Eur J Surg Oncol. 2000; 26: 17-19
        • Malata C.M.
        • McIntosh S.A.
        • Purushotham A.D.
        Immediate breast reconstruction after mastectomy for cancer.
        Br J Surg. 2000; 87: 1455-1472
        • Yuksel F.
        • Celikoz B.
        Double-pedicle TRAM flap breast reconstruction: following Bostwick’s principles.
        Aesthetic Plast Surg. 2002; 26: 444-450
        • Toth B.A.
        • Lappert P.
        Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning.
        Plast Reconstr Surg. 1991; 87: 1048-1053
        • Mosahebi A.
        • Ramakrishnan V.
        • Gittos M.
        • Collier D.S.
        Envelope mastectomy and immediate reconstruction (EMIR), improving outcome without oncological compromise.
        J Plast Reconstr Aesthet Surg. 2006; 59: 1025-1030
        • Dutra A.K.
        • Neto M.S.
        • Garcia E.B.
        • et al.
        The role of transverse latissimus dorsi musculocutaneous flap immediate breast reconstruction.
        Eur J Plast Surg. 2009; 32: 293-299
        • Menke H.
        • Erkens M.
        • Olbrisch R.R.
        Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients.
        Ann Plast Surg. 2001; 47: 107-114
        • Kat C.C.
        • Darcy C.M.
        • O’Donoghue J.M.
        • Taylor A.R.
        • Regan P.J.
        The use of the latissimus dorsi musculocutaneous flap for immediate correction of the deformity resulting from breast conservation surgery.
        Br J Plast Surg. 1999; 52: 99-103
        • Tzilinis A.
        • Lofman A.M.
        • Tzarnas C.D.
        Transfusion requirements for TRAM flap postmastectomy breast reconstruction.
        Ann Plast Surg. 2003; 50: 623-627
        • Elliott L.F.
        • Eskenazi L.
        • Beegle Jr., P.H.
        • Podres P.E.
        • Drazan L.
        Immediate TRAM flap breast reconstruction: 128 consecutive cases.
        Plast Reconstr Surg. 1993; 92: 217-227
        • Hammond D.C.
        Latissimus dorsi flap breast reconstruction.
        Clin Plast Surg. 2007; 34: 75-82
        • Munhoz A.M.
        • Aldrighi C.
        • Montag E.
        • et al.
        Periareolar skin-sparing mastectomy and latissimus dorsi flap with biodimensional expander implant reconstruction: surgical planning, outcome, and complications.
        Plast Reconstr Surg. 2007; 119: 1637-1649
        • Singletary S.E.
        • Allred C.
        • Ashley P.
        • et al.
        Staging system for breast cancer: revisions for the 6th edition of the AJCC cancer staging manual.
        Surg Clin North Am. 2003; 83: 803-819
        • Kronowitz S.J.
        Delayed-immediate breast reconstruction: technical and timing considerations.
        Plast Reconstr Surg. 2010 Feb; 125: 463-474