"Autologous Breast Dermal Filler": A Novel Technique for Breast Reconstruction After Nipple- or Skin-Sparing Mastectomy in Pubertal Gigantomastia.

[BACKGROUND] For females in puberty, mastectomy caused by pathological gigantomastia usually brings significant psychological problems. Appropriate immediate breast reconstruction method is necessary.

[OBJECTIVES] The aim of this study is to present a novel method of breast reconstruction that requires neither implants nor donor-site sacrifice.

[METHODS] All patients who were diagnosed with pathological gigantomastia and indicated for nipple-sparing or skin-sparing mastectomy (NSM or SSM) were selected. All extra skin was de-epithelialized, followed by NSM or SSM through a vertical incision on the lower pole of the breast. Then, a skin and dermal envelope in all directions was formed. Whether to preserve the nipple-areolar complex depended on its perfusion. The dermal flap was folded inward to serve as the "autologous dermal filler" and reconstruct the breast. A second surgery of inframammary fold elevation for larger projection was performed at least 6 months. Follow up for at least 1 year and record complications as well as pre- and postoperative BREAST-Q Scores.

[RESULTS] A total of 11 breasts were included. Four (36.4%) were NSM and seven (63.6%) were SSM. Nipple to sternal notch distance in NSM and SSM was 32.3±9.1cm and 35.1±4.4cm, respectively. No complications occurred, while one breast with NSM showed nipple upward displacement. The BREAST-Q indicated significant postoperative improvements in breast satisfaction (20.5 ± 11.3 vs 80.2 ± 10.4) and psychosocial well-being (23.4 ± 8.9 vs. 81.4 ± 11.3).

[CONCLUSIONS] Preliminary study demonstrated the efficacy and long-term safety of "autologous breast dermal filler." For adolescents, it is a less invasive autologous breast reconstruction method, or transitional plan for further adjustment in adulthood.

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