Skin‐Reducing Mastectomy and Implant Reconstruction: Long‐Term Surgical, Oncological, and Patient‐Reported Outcomes

Background Skin‐reducing mastectomy (SRM) allows implant‐based immediate breast reconstruction in women with large, ptotic breasts. This study aimed to evaluate the surgical and patient‐reported outcomes (PRO) following SRM. Methods A retrospective analysis was conducted on patients who underwent SRM between January 2011 and December 2014. Surgical complications, oncological outcomes, and PRO (using BREAST‐Q) were collected, with a median follow‐up of 10 years. Results Fifty‐five women (95 breasts) underwent SRM and completed the first round of the BREAST‐Q questionnaire. 82.3% ( n = 45) had SRM for cancer treatment, and the remaining had risk‐reducing surgery. 83.6% ( n = 46) had direct‐to‐implant reconstruction, and the remainder had a tissue expander inserted. The mean breast weight was 714 g, and the mean implant volume was 398 mL. The overall complication rate was 58.9%. The most common complication was skin loss due to flap/skin necrosis (24.2%), followed by capsular contracture (18.9%), seroma (7.4%), wound dehiscence (5.3%), implant infection (2.1%), and bleeding (1%). The early implant loss rate was 10.5%. At 10 years ( n = 17), the local recurrence rate was 4.4%, the overall survival rate was 97.7%, and the disease‐free survival rate was 88.9%. Breast‐Q scores were comparable to previous studies (mean score of 65.33). 30.9% of patients ( n = 17) completed the modified BREAST‐Q questionnaire at 10 years of follow‐up. Reconstructed breast satisfaction was high, and 76.5% of patients would choose to undergo SRM again if given the option. Conclusion In certain patients with larger breasts, SRM can facilitate implant‐based immediate breast reconstruction without the need for mesh. Despite relatively high complication rates, patient satisfaction remains high.