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Case Report Plastic and Aesthetic Research

A novel approach to achieve breast

symmetry in a single-stage procedure

Benedetto Longo, Rosaria Laporta, Marco Pagnoni, Fabio Santanelli di Pompeo

Department of Plastic Surgery, Sant’ Andrea Hospital, School of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy.
Address for correspondence: Prof. Fabio Santanelli di Pompeo, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
E-mail: fabio.santanelli@uniroma1.it

ABSTRACT
Preservation of the skin envelope and the inframammary fold is the main factor in achieving breast
symmetry in unilateral reconstruction. Skin sparing mastectomy (SSM) type-IV followed by immediate
autologous reconstruction and contralateral symmetrization permits realizing this goal in large, ptotic
breasted patients, and tumor superficially located in the inferior quadrants. If the tumor is superficially
located in the superior or inferior quadrants with a previous lumpectomy or quadrantectomy scar
in the superior quadrants, modified radical mastectomy and a staged procedure are recommended
to avoid poor cosmetic results. Two patients who underwent immediate autologous reconstruction
following SSM type-V with contralateral symmetrization in a one-stage procedure are presented.

Key words:
Autologous tissue reconstruction, breast symmetry, deep inferior epigastric perforator flap, single-stage
breast reconstruction, wise-pattern mastectomy

INTRODUCTION may be preferred to avoid a poor cosmetic result. This
report presents two patients who underwent simultaneous
The re‑creation of a natural‑appearing breast mound while contralateral mastopexy during unilateral SSM‑V, followed
simultaneously achieving symmetry with the opposite by immediate deep inferior epigastric perforator (DIEP)
breast represents a complex challenge during unilateral flap reconstruction, as a complete single‑stage procedure
reconstruction. [1,2] for upper quadrant skin and tumor resection.
Skin‑sparing mastectomy type‑IV (SSM‑IV), followed by
immediate autologous reconstruction, and a simultaneous CASE REPORT
contralateral procedure is an ideal technique for large,
ptotic‑breasted patients with tumor located in the Case 1
inferior quadrants (IIQQ). However, if the tumor is A 56‑year‑old non‑smoking woman was diagnosed with
located in the superior quadrants (SSQQ) or IIQQ with a phyllodes tumor located deeply to IIQQ of her right breast.
prior lumpectomy or quadrantectomy scar in the SSQQ, Medical history included repeated excisions of lumps and
SSM‑IV is contraindicated. In these cases, tumor resection a superior‑lateral quadrantectomy of the right breast. She
interferes with wise‑pattern (WP) skin flaps, and a modified had large (C bra‑cup), ptotic (second‑degree) breasts with a
radical mastectomy is instead recommended. As a result, mid‑clavicular to nipple distance of 28 cm. She underwent a
a contralateral procedure to achieve symmetry becomes a right SSM‑V, axillary lymph‑node dissection and immediate
complex, multifactorial decision, and a staged procedure reconstruction with a 13 cm × 21 cm de‑epithelialized
DIEP flap. Her nipple areola‑complex (NAC) was grafted,
Access this article online and a simultaneous contralateral mastopexy was
Quick Response Code: performed. The postoperative course was uneventful,
Website: and no complications were observed at the DIEP flap,
www.parjournal.net
SSM‑V skin flaps, contralateral mastopexy, or and to the
abdominal donor site. Breast symmetry of shape and size
DOI: was achieved [Figures 1 and 2]. Neither surgical revision
10.4103/2347-9264.153204 nor secondary procedures were required at her 20 months
follow‑up.

76 Plast Aesthet Res || Vol 2 || Issue 2 || Mar 13, 2015