Esthetic evaluation of immediate breast reconstruction after nipple-sparing or skin-sparing mastectomy.

BACKGROUND: It has been reported that immediate autologous tissue breast reconstruction after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) is esthetically superior to autologous tissue reconstruction after conventional mastectomy (CM). We evaluated reconstructed breasts to determine whether these methods contribute to breast appearance other than skin texture. METHODS: Between April 1992 and September 2001, forty-two patients underwent immediate breast reconstruction using autologous tissue. Mastectomy options were NSM, SSM and CM. Postoperative photographs were evaluated using a subscale (volume, contour, placement, and inframammary fold) on a 0-2 point scale. Sternal notch to nipple distances of the affected and normal sides were measured with photographs to estimate nipple-areola complex (NAC) position. No corrective procedure was performed in a later phase before evaluation. RESULTS: NSM was performed in 22, SSM in 6 and CM in 14 cases. On esthetic evaluation, the NSM and SSM groups received 4.96 and the CM group received 4.63. There were no significant differences. In the NSM and SSM group, the NAC position rose in cases with partial necrosis or fat lysis compared with the no complication group (p = 0,004). CONCLUSIONS: Autologous tissue breast reconstruction after NSM or SSM is esthetically equal to autologous tissue reconstruction after CM with regard to parameters other than skin texture. Preserved or simultaneously reconstructed NAC sometimes emphasizes nipple-areola asymmetry when breast deformity has occurred.

Secure flap fixation to bony tissue using an anchoring system in skull-base surgery.

The reconstruction of extensive skull-base defects using flap transfer decreases crucial postoperative complications. However, flap fixation to bony tissue is often difficult, especially if there is no soft tissue to pass sutures through, and unsteady flap fixation causes dead space formation or displacement of the transferred flap due to gravity. The authors used an anchoring system for secure flap fixation in seven cases with difficult flap fixation, using the conventional suturing technique. Anchors were inserted at strategic points in the bony tissue, and secure flap fixation was achieved in all cases. Postoperative CT scans showed no dead space formation, and major postoperative complications were not observed. The anchoring system can be buried in bony tissue with a thickness of more than 4 mm, and it enables reliable flap fixation and dead space obliteration. Although the cost is relatively high, the procedure is simple and lowers the risk of crucial postoperative complications in skull-base surgery.