Investigation of 72 Patients Following Subcutaneous Mastectomy: A Clinical Evaluation of Current Surgical Techniques

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Abstract
Different surgical techniques for subcutaneous mastectomy (SCM) have been evaluated and compared in this retrospective study of 72 patients. It has been clearly demonstrated that SCM followed by immediate reconstruction is a serious operation with a high frequency of both primary and late complications. It is important to have strong indications and a well informed and motivated patient before performing an SCM. A high frequency of postoperative tissue necroses was found for breasts of over 500 grams, when operated on using technique (VI) which entails skin reduction and transposition of the nipple-areola complex. In the very large breast a total mastectomy with skin reduction and transplantation of the nipple-areola complex is recommended. To obtain a good take of the graft it is advantageous to postpone the insertion of the prosthesis until a later occasion. For small breasts the lazy-S-shaped horizontal incision (technique V) is recommended. This technique gave perfect accessibility to the gland together with good cosmetic results and satisfied patients. At the follow-up examination it was found that the size and position of the implants were appropriate in about 80% of the breasts. Twenty-five percent of the breasts were somewhat hard, although acceptable. The majority of the implants, however, were soft. The erotic sensibility of the breast is lost after an SCM. Furthermore, in 23% of the breasts there was no sensitivity at all in the nipple-areola complex 2 years or more after the operation. Accordingly, we conclude that the operative technique of choice depends primarily on the size of the breast.

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