Mastectomy Through a Vertical Incision

The standard modified radical mastectomy includes removal of the breast gland with the nipple-areola complex (NAC) as well as the skin overlying the tumor. However, more conservative techniques have been used if the tumor is not too close to the skin. Pe-riareolar incision is used widely nowadays to perform the mastectomy, which allows the removal of the gland with the NAC. Besides immediate reconstruction, excellent aesthetic results can be obtained. A vertical component can be added to the periareolar incision in the following cases:

™ If the NAC is small, which does not allow for gland removal.

™ Reducing the size of the skin pocket to achieve a smaller size of the reconstructed breast. ™ Removal of the skin over the tumor using elliptic skin excision as part of a vertical scar mammaplas-ty.

In the first case, we prefer to increase the access to the breast by a vertical incision because this scar usually heals well with good quality. Moreover, a mastopexy can be carried out better through this scar should the patient need a further correction in the future.

Vertical Scar Breast Reduction
Fig. 12.1. a Preoperative view: patient who had a breast cancer located at the inferomedial quadrant as marked by harpoon. b Postoperative view: the breast was remodeled by a vertical scar mammaplsty with a superior pedicle after tumor resection
Breast Reduction Incisions

Fig. 12.2. a A patient who had a breast cancer above the nipple-areola complex but within the incision lines. The pedicle can be designed either laterally or medially to fill the defect post quad-

Fig. 12.2. a A patient who had a breast cancer above the nipple-areola complex but within the incision lines. The pedicle can be designed either laterally or medially to fill the defect post quad-

In the last two cases, the design of vertical scar mammaplasty can be done to immediately reduce the reconstructed breast or to fit the incision pattern in such a way that the skin overlying the tumor is included within the vertical mammaplasty either within the dome-shaped excision around the NAC or within the vertical elliptic excision.

Oncologically, breast-conserving surgery for cancer, associated with postoperative radiotherapy, has proved safe as compared with total mastectomy for tumors up to 3 cm in diameter. Larger tumors are still treated with mastectomy as the first choice. However, rantectomy. b A patient with a tumor located above the nipple-areola complex and extended beyond the incision lines more efficient protocols of neoadjuvant chemotherapy may allow a more conservative local approach to advanced tumors. The combination of a quardantec-tomy with an immediate partial breast reconstruction is considered a decisive stage in the evolution of breast cancer surgery. This combination, so-called "oncoplastic surgery," allows a wider resection of the tumor with safe margins, together with the advantages of the immediate breast reconstruction by using a supple, malleable nonirradiated tissue in order to achieve both ultimate goals: adequate local control of the disease and good aesthetic results (Fig. 12.1a, b).

Here, too, a vertical mammaplasty pattern can be designed to incorporate the tumor excision within the lines of incision (Fig. 12.2 a). The pattern can be rotated laterally or medially to fit the location of the tumor.

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