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NESPS 27th Annual Meeting Abstracts

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The Aesthetic Mastectomy Utilizing a Non Nipple- Sparing Portal Approach
Anthony C. Cahan, MD FACS, David A. Palaia, MD FACS, Michael H. Rosenberg, MD FACS, Philip C. Bonanno, MD FACS.
Northern Westchester Hospital, Mount Kisco, NY, USA.

Background:
Increasingly, patients are basing decisions for the treatment of their breast cancer on the aesthetic as well as oncologic outcomes. The aesthetic mastectomy, although sounding like an oxymoron, has become the expected result. Among the criteria for aesthetic acceptance of a reconstructed breast is the lack of discernible scars on the breast, a pleasing mound of adequate size, a natural appearing nipple-areolar complex, the position of an appropriate IMF, with minimal complications and a high level of predictability which aids in achieving symmetry in cases of bilateral mastectomy.
Methods:
The authors describe a new incision and closure for the skin sparing mastectomy which affords a wide field of exposure for the ablative oncological breast surgery as well as the primary breast reconstruction utilizing a dermal matrix plus an alloplastic implant. This new portal approach offers better access than standard periareolar incisions. The reconstruction, placing the surgical incisions within the future nipple areolar complex diameter, when closed and subsequently tattooed, results in a virtually scarless mastectomy.
Results:
This technique has been employed in 81 patients with 134 skin sparing mastectomies with immediate alloplastic reconstruction.
Complete camouflage of the mastectomy scar within the nipple areolar complex was achieved in 76 of 81 patients (94%). The complication rate requiring removal of the implant was 6%, and minor wound complications and seroma was 14%.
Conclusion:
We have introduced a new surgical portal for the performance of a skin sparing mastectomy with a closure we refer to as the "Box to X" technique, providing larger access for dissection as compared to a standard periareolar incision, while containing the entire scar within the original nipple/areolar complex. Following nipple/areolar reconstruction and tattooing, the result is a non visible scar mastectomy. The authors' experience using this technique on 81 patients with 134 mastectomies over 41 months is described.


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