Mastectomy Incision Design to Optimize Aesthetic Outcomes in Breast Reconstruction

Abstract

Background: Choosing the optimal mastectomy incision must account for oncologic, reconstructive, and aesthetic considerations, including nipple preservation, mastectomy skin margins and potential for skin involvement, mastectomy skin perfusion and viability, mastectomy skin excess, previous breast scars, the reconstructive plan, and inconspicuous new scar placement. In the present study, we aimed to assess breast reconstruction aesthetics, as they are influenced by mastectomy incision design. Methods: Nine commonly utilized mastectomy incision patterns were grouped into 3 categories: hidden scar, vertical scar, and transverse scar. Twenty plastic surgeons were asked to blindly grade before and after photographs of reconstructed breasts with regard to scar visibility and position and according to their influence on breast aesthetics. Results: Statistically significant differences were observed between the study groups. Mastectomies and reconstructions performed through hidden incisions yield the most aesthetic results. Vertical scars are favorable to transverse scars. In the case of bilateral reconstructions, symmetric scar placement is paramount to optimizing aesthetic outcomes. Conclusions: The mastectomy incision pattern significantly affects the aesthetic outcomes in breast reconstruction. Patterns borrowed from cosmetic breast surgery consistently yield highly aesthetic outcomes. Surgeons must consider oncologic factors and patient characteristics in choosing an ideal incision for each patient.

Effectiveness of SCAR‐Q for assessment of incisional SCAR after implant‐based reconstruction in breast cancer patients: Can it be a tool for incision selection?

“…12 Regarding incision scars in mastectomies, evaluations of the cosmetic appearance by medical personnel suggest that the hidden incision line (external to breast areas) is the most aesthetic in nipple-sparing mastectomy (NSM) cases, while vertical scars are better than horizontal scars in skin-sparing mastectomy (SSM). 13 The results reported for NSM are similar to our results.…”

Breast reconstruction with latissimus dorsi flap: a comprehensive review and case series

“…Most procedures were skin-sparing mastectomies (94.4%). According to the classification of Lotan et al ( 9 ), the most common patterns for mastectomy incisions were transverse (63.7%) and the wise pattern (15.8%). SPY fluorescence imaging was used to assess perfusion of mastectomy skin flaps in 13.2% of the cases ( Table 3 ).…”

Identification of Independent Risk Factors for Skin Complications in a Multifactorial Logistic Regression Analysis of Simultaneous Immediate Autologous Breast Reconstruction and Skin Reduction Mastectomy in Large and Ptotic Breasts Using an Inferiorly Based Deepithelialized Dermal Breast Flap

“…Comparing our complication rates to other studies is difficult as, to the best of our knowledge, this is the first study reporting exclusively on autologous IBR in combination with wise pattern skin reducing mastectomies with an adipocutaneous IBDF in large and ptotic breasts. All other studies focus on alternative reconstructive strategies, such as using the IBDF in skin reducing mastectomies but only implant based IBR [ 12 , 13 , 14 ], or using wise pattern incisions without the IBDF [ 3 , 4 , 11 , 15 , 16 , 17 ]. In a systematic review of 31 studies (1128 cases) by Tondu et al on breast reconstruction after NSM in large and ptotic breasts, the overall complication rate was 29.1%, which is comparable to ours [ 4 ].…”