Aesthetic Plastic Surgery

, Volume 34, Issue 1, pp 71–77 | Cite as

Skin-Reducing Subcutaneous Mastectomy Using a Dermal Barrier Flap and Immediate Breast Reconstruction with an Implant: A New Surgical Design for Reconstruction of Early-Stage Breast Cancer

  • Yalcin Bayram
  • Yalcin Kulahci
  • Ceyhun Irgil
  • Murat Calikapan
  • Nurettin Noyan
Original Article



The development of skin-sparing mastectomy techniques for early-stage breast cancer has opened a new era in reconstructive breast surgery. Because of improved early diagnoses, the demand for skin-sparing techniques continues to increase more than ever.


Between March 2006 and April 2008, skin-reducing subcutaneous mastectomy (SRSM) using the dermal barrier flap technique and simultaneous breast reconstruction with silicone implants was performed for 15 patients (a total of 26 breasts) who had either a diagnosis of early-stage breast cancer or indications for prophylactic mastectomy. Of the 15 patients, 11 underwent bilateral reconstruction. The remaining four patients underwent unilateral reconstruction using SRSM with the dermal barrier flap technique.


The average age of the patients who underwent SRSM with the dermal barrier flap was 45.7 years. All the patients were discharged from the hospital on postoperative day 1. The mean follow-up period was 12 months, and the recovery time was 35 days. Excellent aesthetic results and uneventful healing were obtained for 23 breasts. Partial nipple–areola necrosis occurred in two breasts. Total skin necrosis in the bilateral nipple–areola and central breast region occurred for one patient who underwent bilateral SRSM. Prosthesis exposure was not observed for any of these patients.


The authors present their early results with SRSM using the dermal barrier flap and silicone implants for early-stage breast cancer. The dermal barrier flap became a reliable procedure by providing a decreased breast envelope, eliminating the risk of implant exposure, and forming a double layer of dermal tissue at the incision line.


Dermal barrier flap Early-stage breast cancer Implant Skin-reducing subcutaneous mastectomy 


  1. 1.
    Hinton CP, Doyle PJ, Blamey RW, Davies CJ, Holliday HW, Elston CW (1984) Subcutaneous mastectomy for primary operable breast cancer. Br J Surg 71:469–472CrossRefPubMedGoogle Scholar
  2. 2.
    Gerber B, Krause A, Reimer T et al (2003) Skin-sparing mastectomy with conservation of the nipple–areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 238:120–127CrossRefPubMedGoogle Scholar
  3. 3.
    Cunnick GH, Mokbel K (2004) Skin-sparing mastectomy. Am J Surg 188:78–84CrossRefPubMedGoogle Scholar
  4. 4.
    Nahabedian MY, Tsangaris TN (2006) Breast reconstruction following subcutaneous mastectomy for cancer: a critical appraisal of the nipple–areola complex. Plast Reconstr Surg 117:1083–1090CrossRefPubMedGoogle Scholar
  5. 5.
    Crowe JP Jr, Kim JA, Yetman R, Banbury J, Patrick RJ, Baynes D (2004) Nipple-sparing mastectomy: technique and results of 54 procedures. Arch Surg 139:148–150CrossRefPubMedGoogle Scholar
  6. 6.
    Vlajcic Z, Rado Z, Stanec S, Stanec Z (2006) Nipple–areola complex preservation. Plast Reconstr Surg 118:1493–1495CrossRefPubMedGoogle Scholar
  7. 7.
    Hartmann LC, Schaid DJ, Woods JE et al (1999) Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340:77–84CrossRefPubMedGoogle Scholar
  8. 8.
    Yiacoumettis AM (2005) Two-staged breast reconstruction following prophylactic bilateral subcutaneous mastectomy. Br J Plast Surg 58:299–305CrossRefPubMedGoogle Scholar
  9. 9.
    Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA (2007) Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol 25:5203–5209CrossRefPubMedGoogle Scholar
  10. 10.
    Metcalfe KA, Semple JL, Narod SA (2004) Satisfaction with breast reconstruction in women with bilateral prophylactic mastectomy: a descriptive study. Plast Reconstr Surg 114:360–366CrossRefPubMedGoogle Scholar
  11. 11.
    Singletary SE (2001) New issues in surgical management. In: Bonadonna G, Hortobagyi G, Gianni AM (eds) Textbook of breast cancer. Martin Dunitz, Taylor & Francis, Oxford, UK, pp 113–115Google Scholar
  12. 12.
    Jones NB, Wilson J, Kotur L, Stephens J, Farrar WB, Agnese DM (2009) Contralateral prophylactic mastectomy for unilateral breast cancer: an increasing trend at a single institution. Ann Surg Oncol 16:2691–2696CrossRefPubMedGoogle Scholar
  13. 13.
    Yi M, Meric-Bernstam F, Middleton LP, Arun BK, Bedroisan I, Babiera GV et al (2009) Predictors of contralateral breast cancer in patients with unilateral breast cancer undergoing contralateral prophylactic mastectomy. Cancer 115:962–971CrossRefPubMedGoogle Scholar
  14. 14.
    Freeman BS (1962) Subcutaneous mastectomy for benign breast lesions with immediate or delayed prosthetic replacement. Plast Reconstr Surg Transplant Bull 30:676–682PubMedGoogle Scholar
  15. 15.
    Toth BA, Lappert P (1991) Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstr Surg 87:1048–1053CrossRefPubMedGoogle Scholar
  16. 16.
    Nava MB, Cortinovis U, Ottolenghi J et al (2006) Skin-reducing mastectomy. Plast Reconstr Surg 118:603–610CrossRefPubMedGoogle Scholar
  17. 17.
    Benediktsson KP, Perbeck L (2008) Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg Oncol 34:143–148PubMedGoogle Scholar
  18. 18.
    Carlson GW, Bostwick J III, Styblo TM (1997) Skin-sparing mastectomy: Oncologic and reconstructive considerations. Ann Surg 225:570–575CrossRefPubMedGoogle Scholar
  19. 19.
    Tuttle T, Habermann E, Abraham A, Emory T, Virnig B (2007) Contralateral prophylactic mastectomy for patients with unilateral breast cancer. Expert Rev Anticancer Ther 7:1117–1122CrossRefPubMedGoogle Scholar
  20. 20.
    Jabor MA, Shayani P, Collins DR Jr, Karas T, Cohen BE (2002) Nipple–areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg 110:457–463CrossRefPubMedGoogle Scholar
  21. 21.
    Shestak KC, Gabriel A, Landecker A, Peters S, Shestak A, Kim J (2002) Assessment of long-term nipple projection: A comparison of three techniques. Plast Reconstr Surg 110:780–786CrossRefPubMedGoogle Scholar
  22. 22.
    Gruber RP, Kahn RA, Lash H, Maser MR, Apfelberg DB, Laub DR (1981) Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques. Plast Reconstr Surg 67:312–317PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2009

Authors and Affiliations

  • Yalcin Bayram
    • 1
  • Yalcin Kulahci
    • 2
  • Ceyhun Irgil
    • 3
  • Murat Calikapan
    • 4
  • Nurettin Noyan
    • 2
  1. 1.Department of Plastic and Reconstructive SurgeryBursa Military HospitalBursaTurkey
  2. 2.Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy and Medical FacultyHaydarpasa Training HospitalIstanbulTurkey
  3. 3.Bursa Breast Surgery ClinicBursaTurkey
  4. 4.Department of General SurgeryBursa Oncology HospitalBursaTurkey

Personalised recommendations