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The breast reconstruction using autologous tissue has many advantages but still results in long visible scar across the chest, deficit of breast envelope, and mismatching of skin color with transferred autologous tissue. Recently, many surgeons favor skin-sparing mastectomy: technique of reserving major portion of the breast envelope during mastectomy. Authors performed breast reconstruction after skin-sparing mastectomy in 43 patients of breast cancer for 3 years. Periareolar incision was used with an additional incision medially, laterally or axillary incision if needed. In all cases the breast reconstruction was performed immediately after mastectomy. We had 3 cases of tissue expanders, 10 cases of breast implants, 29 cases of TRAM flaps including one free TRAM, and 1 case of lattissimus dorsi musculocutaneous flap. The mean follow-up period was 18.8 months. As a result, the long scar was avoided with a small key-hall shape scar. Gross color mismatching was resolved, and more symmetric and natural looking breast mound was made. Complications were minimal: skin flap necroses in 2 cases, infection and hematoma in 3 cases. Compared with modified radical mastectomy, skin-sparing mastectomy has advantages: small scar, maintainence of inframammary fold, unique skin color with enough breast envelope, and easy construction of symmetric breasts. We suggest that skin-sparing mastectomy is one of the key factors in the reconstruction of more natural-looking breast.
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