Srećko Budi

Skin and nipple-areola complex sparing mastectomy in breast cancer patients: 15-year experience.

AbstractSkin and nipple-areola complex sparing mastectomy (SNSM) and primary reconstruction have been popular for breast cancer treatment in the last decade. An advantage of the SNSM technique is the removal of all breast tissue as a radical surgical procedure while preserving native breast integrity, nipple-areola complex (NAC), and submammary fold. This retrospective 15-year clinical study analyzes medical records from our breast surgery database collected at our department between 1997 and 2012. A total number of 3757 patients were treated for breast cancer; 411 (10.9%) patients had a skin-sparing mastectomy with the median (range) length follow-up of 63 months. This is the longest follow-up for SNSM in breast cancer patients; 3.7% of patients who underwent SNSM developed disease local recurrence, whereas occult NAC involvement with cancer occurred in 7.7% and local recurrence in the NAC in 1.2%. Partial necrosis of the NAC developed in 9.4% and total necrosis in 0.7% of operated breasts. All disease recurrences occurred in the first 10 years of the follow-up period. Local recurrence developed as first recurrence event has longer median cancer-specific survival time of 70 months than those with only distant metastases with 50 months and locoregional plus distant metastases with 35.5 months. The “Omega” pattern incision combines an oncological radical procedure with a lower incidence of skin flap necrosis. Patients reconstructed with autologous tissue were the group most satisfied. SNSM is an oncological safe procedure for breast cancer treatment with low recurrence in properly selected patients.

Skin-sparing mastectomy with nipple-areola conservation.

The authors emphasize their indications for skin-sparing mastectomy with nipple-areola complex preservation and present their protocol for treatment of patients with breast cancer.

Deep inferior epigastric perforator flap: a modification that simplifies elevation.

The deep inferior epigastric perforator flap is accepted worldwide as a reliable and relatively safe technique for autologous breast reconstruction. Preserving the continuity of the rectus muscle, it reduces donor site morbidity, allowing less postoperative pain, a faster recovery, and a reduced hospital stay. Nevertheless, the more complex nature of this type of surgery leads to increased operating time and a demand for more tedious microsurgical dissection. The authors present a modification of the deep inferior epigastric perforator flap harvesting technique that allows a more safe, simple, and faster elevation of the flap. They have used it successfully for breast reconstruction in 3 patients.

Simultaneous dermal graft harvesting and de-fatting

Even after careful excision of full-thickness skin graft, some fat usually remains on the undersurface of the graft and has to be removed by additional trimming using sharp, curved scissors. The de-fatting of the fat on the dermal side of the full-thickness skin graft is usually a time-consuming procedure. We would like to propose an extremely simple modification of excision and simultaneous de-fatting of dermal skin graft. The ellipse shape of the dermal grafting is elevated with a # 15 blade rolling the epidermal surface of the graft over a syringe with one hand, exposing the dermal side to be simultaneously de-fatted with the blade in the other hand (Figure 1). Better exposition of the dermal side of the skin graft can be additionally facilitated by grasping the top of