Background:
Patients who desire faster recovery after mastectomy can opt for an Aesthetic Flat Closure (AFC) instead of traditional autologous and prosthetic reconstructive options. AFC is an evolving area of reconstructive surgery in breast reconstruction and there have been no nipple-sparing techniques demonstrated to date. Amongst AFC, a wise pattern and inferior dermal pedicle containing the nipple can be used to create a breast mound. Other patients can have a double incision mastectomy with or without a free nipple graft. Our case series demonstrates a novel nipple-sparing AFC surgical technique by the senior author and reviews postoperative outcomes.
Methods:
A retrospective chart review of patients who received post-mastectomy AFC between August 2021 to April 2024 was conducted. Figure 1a-1d details key operative steps of the surgical technique.
Results:
A review of 18 post-mastectomy AFC patients were reviewed, with 77.8% undergoing immediate reconstruction and 83.3% receiving bilateral procedures. The majority (88.9%) of patients had a history of breast cancer two patients undergoing a prophylactic mastectomy. The average age was 54.8±10.7 years old with a body mass index of 31.8± 8.7 kg/m2 . Mean operative time for immediate AFC was 167±47. Intraoperatively, a wise pattern was used in 11.1% of patients and double incisions was used in 88.9%.
The mean resection weight was 1038±774.8 grams per breast and average area of the de-epithelialized inferior adipodermal flap was 264.9 cm2. Three patients received free nipple grafts. A total of 11.1% patients had minor dehiscence that required local wound care. A total 11.1% (n=2) had major complications requiring reoperation, one for a hematoma and another for positive margins. A total of 11.1% (n=2) received revisions for aesthetic reasons.
Conclusion:
This novel nipple-sparing Aesthetic Flat Closure is a customizable, fast, and safe operation that yields successful results and a relative minimum of complications in patients seeking aesthetic flat closure reconstruction after mastectomy.
