Trans-Vertical Mastectomy With Immediate Implant-Based Reconstruction: A Retrospective, Observational Study

Abstract

Background

In women with large and ptotic breasts requiring a mastectomy and immediate, implant-based reconstruction, long flaps pose a high risk for flap ischemia and necrosis. A new trans-vertical incision for skin-reducing mastectomy is described, which reduces the skin envelope and lifts the breast.

Objective

To describe the new mastectomy access incision and assess its efficacy and safety when followed by immediate implant-based reconstruction.

Methods

This is a retrospective analysis of 70 consecutive patients (101 breasts) with large and ptotic breasts undergoing a unilateral (n=39; 55.7%) or bilateral (n=31; 44.3%) skin-reducing mastectomy using the trans-vertical approach, either for breast cancer or risk reduction. All received immediate one- (n=86; 85.5%) or two-stage (n=15; 14.5%) implant-based reconstruction using acellular dermal matrix.

Results

Mean age was 50.1 years and mean body mass index (BMI) was 25.6 kg/m². After a median follow-up of 4.9 years, the number of breasts with minor and major complications was 21 (20.8%) and 26 (25.7%), respectively. The most common major complications were skin-flap necrosis (n=12; 11.9%) and infection (n=8; 7.9%). All occurred within 3 months post-surgery. There were 7 cases of capsular contracture (6.9%), and 5 reconstruction failures (5.0%). Higher BMI (p<0.01) and breast weight (p<0.05) were associated with increased complication rates. According to BREAST-Q, 55/64 patients (85.9%) were somewhat or very satisfied with the aesthetic outcome.

Conclusions

The trans-vertical approach is an effective, reproducible and safe alternative to conventional skin-reducing mastectomy, with favorable aesthetic outcomes, in patients with large and ptotic breasts.