Background The advent of skin-sparing mastectomy has allowed for the reconstruction of the
breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC)
in Asian patients is more pigmented and scars easily. Therefore, commonly described
incisions tend to result in poor aesthetic outcomes in Asian patients with breast
cancer.
Methods We describe an algorithmic approach to skin-sparing mastectomy incisions in Asian
patients on the basis of the location of the biopsy scar and the tumor site and size.
Four incision types are described: peri-areolar, a peri-areolar incision with a second
distant skin paddle, "racquet handle," and peri-areolar with adjacent skin excision.
Results 281 immediate breast reconstructions were performed between May 2001 and February
2012 after skin-sparing mastectomy. The mastectomy incisions used included the peri-areolar
design (n=124, 44%), peri-areolar design with a second distant skin paddle (n=39,
14%), "racquet handle" (n=21, 7.5%), and peri-areolar design with adjacent skin excision
(n=42, 14%). The traditional elliptical incision and other variants where the NAC
outline was not preserved were performed in the remaining 55 patients. The average
follow-up was 44.7 months during which there was 1 case of total flap loss and 7 cases
of partial flap necrosis; all remaining flaps survived. 24% of the patients (68/281)
underwent subsequent nipple reconstruction.
Conclusions Our algorithm avoids breast incisions that are randomly placed or excessively long
and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparing
mastectomy and immediate breast reconstruction to be performed with a consistently
achievable aesthetic result in Asian women without neglecting oncological safety.
Keywords
Mastectomy - Mammaplasty - Breast - Asia - Esthetics
