British Journal of Plastic Surger)~ (1978), 31, a+-~.5
IMMEDIATE RECONSTRUCTION WITHOUT PROSTHESES FOLLOWING SUBCUTANEOUS MASTECTOMY IN LARGE BREASTS By EVALDO ALVESD’ASSUMP~AO SOPLAR-Hospital
de Cirurgia Plastica, Rua Espirito Santo 2546, 30,000 Belo Horizonte, MG, Brasil
THE widely used term “subcutaneous” applied to mastectomy is a misnomer. Extirpation of the glandular tissue alone leaves behind not just skin but also a layer of fat of varying thickness. In Brazil, as in other countries, large breasts, although frequently found, are not desired by women nor appreciated by men. In women who require subcutaneous mastectomy for any reason and who also have large breasts, the breast can be immediately reconstructed following the glandular excision without the use of an expensive prosthesis by making use of the remaining skin and fat. The result is in effect a reduction mammaplasty. The technique to be described is modified from the dermofat flaps of Longacre !;!I.?~ which seem to have been largely forgotten in the almost universal use of silicone .
The preoperative
markings are made with the patient sitting.
03
02
01
The new nipple site
The new nipple point has been marked and the usual W incision for breast reduction made. The area of skin (F) between this and the submammary fold has been de-epithelialised.
FIG. I.
FIG. 2. The lower dermofat flap and the upper skin and fat flap have been reflected from the gland. The nipple and areola have been dissected as a full-thickness graft leaving behind the breast tissue underneath and the ducts. FIG. 3.
The dermofat flap is folded into a conical shape and covered with the flaps F’. nipple are finally transplanted. 24
The areola and
SUBCUTANEOUS
MASTECTOMY
FIG. 4.
IN
LARGE
BREASTS
25
(a), (b), (cj, :d) Typical case pre- and 6 monrhs postoperatively.
is selected on the mid-clavicular-nipple line and the breast marked as for a reduction mammaplasty with free nipple transplantation (Fig. I). At operation the whole area between the W incision and the submammary fold is de-epithelialised (D’Assumpcab, 1975). The areola and nipple are removed as a full thickness skin graft thus allowing the breast tissue and ducts underneath to be excised with the rest of the gland. The W incision is now deepened until breast tissue is reached and the upper flap of skin and fat and the lower of dermis and fat are dissected from it (Fig. 2). When the breast tissue has been completely removed the dermofat flap is folded into a conical shape and covered with the upper flap as shown in Figure 3. The areola and nipple are applied as a free graft in the usual way. In selected cases, a Skoog (1963) flap can be used to preserve vascular supply for the areola. In the not-so-very-large breast a small prosthesis may be inserted under the dermofat flap to give added prominence. RESULTS
Over 30 patients have now been operated on by this technique without significant A typical case is shown in Figure 4. complications. REFERENCES E. A. (1975). Breast Amputation-Personal Technical Variety. Revista de Cirugia, 65, rzg. The use of local pedicle flaps for reconstruction of the breast after LONGACRE, J. J. (1953). sub-total or total extirpation of the mammary gland and for the correction of distortion and atrophy of the breast due to excessive scar. Plastic and Recomtructive Surgeqv, II, 380. Skoog, T. (1963). A technique of breast reduction, Acta Chirurgica Scandinavica, 126, I D’Assumpcao, Brasileira
IMMEDIATE RECONSTRUCTION WITHOUT PROSTHESES FOLLOWING SUBCUTANEOUS MASTECTOMY IN LARGE BREASTS By EVALDO ALVESD’ASSUMP~AO SOPLAR-Hospital
de Cirurgia Plastica, Rua Espirito Santo 2546, 30,000 Belo Horizonte, MG, Brasil
THE widely used term “subcutaneous” applied to mastectomy is a misnomer. Extirpation of the glandular tissue alone leaves behind not just skin but also a layer of fat of varying thickness. In Brazil, as in other countries, large breasts, although frequently found, are not desired by women nor appreciated by men. In women who require subcutaneous mastectomy for any reason and who also have large breasts, the breast can be immediately reconstructed following the glandular excision without the use of an expensive prosthesis by making use of the remaining skin and fat. The result is in effect a reduction mammaplasty. The technique to be described is modified from the dermofat flaps of Longacre !;!I.?~ which seem to have been largely forgotten in the almost universal use of silicone .
The preoperative
markings are made with the patient sitting.
03
02
01
The new nipple site
The new nipple point has been marked and the usual W incision for breast reduction made. The area of skin (F) between this and the submammary fold has been de-epithelialised.
FIG. I.
FIG. 2. The lower dermofat flap and the upper skin and fat flap have been reflected from the gland. The nipple and areola have been dissected as a full-thickness graft leaving behind the breast tissue underneath and the ducts. FIG. 3.
The dermofat flap is folded into a conical shape and covered with the flaps F’. nipple are finally transplanted. 24
The areola and
SUBCUTANEOUS
MASTECTOMY
FIG. 4.
IN
LARGE
BREASTS
25
(a), (b), (cj, :d) Typical case pre- and 6 monrhs postoperatively.
is selected on the mid-clavicular-nipple line and the breast marked as for a reduction mammaplasty with free nipple transplantation (Fig. I). At operation the whole area between the W incision and the submammary fold is de-epithelialised (D’Assumpcab, 1975). The areola and nipple are removed as a full thickness skin graft thus allowing the breast tissue and ducts underneath to be excised with the rest of the gland. The W incision is now deepened until breast tissue is reached and the upper flap of skin and fat and the lower of dermis and fat are dissected from it (Fig. 2). When the breast tissue has been completely removed the dermofat flap is folded into a conical shape and covered with the upper flap as shown in Figure 3. The areola and nipple are applied as a free graft in the usual way. In selected cases, a Skoog (1963) flap can be used to preserve vascular supply for the areola. In the not-so-very-large breast a small prosthesis may be inserted under the dermofat flap to give added prominence. RESULTS
Over 30 patients have now been operated on by this technique without significant A typical case is shown in Figure 4. complications. REFERENCES E. A. (1975). Breast Amputation-Personal Technical Variety. Revista de Cirugia, 65, rzg. The use of local pedicle flaps for reconstruction of the breast after LONGACRE, J. J. (1953). sub-total or total extirpation of the mammary gland and for the correction of distortion and atrophy of the breast due to excessive scar. Plastic and Recomtructive Surgeqv, II, 380. Skoog, T. (1963). A technique of breast reduction, Acta Chirurgica Scandinavica, 126, I D’Assumpcao, Brasileira
