Maximising the preservation of previously irradiated native mammary skin by skin-banking of the autologous flap: Outcome after 33 skin-sparing or nipple-sparing salvage mastectomies

Total ‘salvage’ mastectomy may be indicated for local recurrence or second primary tumour in 3% of women within the first 5 years after breast conserving therapy including whole-breast irradiation (BCT), 1 Jo T. Hur J. Min K. Kim E.K. Han H.H. Eom J.S Immediate breast reconstruction after salvage mastectomy: Case control outcome comparisons of DIEP flap and DTI reconstruction. J Plast Reconstr Aesthet Surg. 2021; 74: 1495-1502 Google Scholar or in 10% within 10 years. 2 Alperovich M. Choi M. Frey J.D. Lee Z.H. Levine J.P. Saadeh P.B. et al. Nipple-sparing mastectomy in patients with prior breast irradiation: Are patients at higher risk for reconstructive complications?. Plast Reconstr Surg. 2014; 134: 202e-206e Google Scholar Although superior aesthetic results of breast reconstruction can in general be achieved with preservation of native mammary skin flaps, 3 Kovach S.J. Georgiade G.S The "banked" TRAM: A method to insure mastectomy skin-flap survival. Ann Plast Surg. 2006; 57: 366-369 Google Scholar ,4 Reichl H. Hladik M. Wechselberger G. Skin banking: Treatment option for native skin necrosis following skin-sparing mastectomy and previous breast irradiation. Microsurgery. 2011; 31: 314-317 Google Scholar combined nipple-sparing or skin-sparing mastectomy ([N]SSM) and immediate autologous breast reconstruction (IABR) is often discouraged because of higher post-radiation complication rates, 4 Reichl H. Hladik M. Wechselberger G. Skin banking: Treatment option for native skin necrosis following skin-sparing mastectomy and previous breast irradiation. Microsurgery. 2011; 31: 314-317 Google Scholar with mammary skin flap necrosis occurring in up to 27% of these women. 1 Jo T. Hur J. Min K. Kim E.K. Han H.H. Eom J.S Immediate breast reconstruction after salvage mastectomy: Case control outcome comparisons of DIEP flap and DTI reconstruction. J Plast Reconstr Aesthet Surg. 2021; 74: 1495-1502 Google Scholar ,2 Alperovich M. Choi M. Frey J.D. Lee Z.H. Levine J.P. Saadeh P.B. et al. Nipple-sparing mastectomy in patients with prior breast irradiation: Are patients at higher risk for reconstructive complications?. Plast Reconstr Surg. 2014; 134: 202e-206e Google Scholar