Breast reconstruction after a mastectomy is being performed in many cases by using a tissue expander or a TRAM flap. However, a conventional mastectomy leaves long linear scar formation on the breast skin after reconstruction. A skin-sparing mastectomy (SSM) with one-stage star flap nipple-areolar complex immediate reconstruction makes minimal scar tissue, and with a circumferential incision is made around the nipple, becoming vil1ually imperceptible. The purpose of this study is to identify the clinical indications, to evaluate the clinical results, and to encourage the application of this method for the indicated patients.

During the recent 3 years, 1996 through 1999, there were 1027 breast-cancer surgeries. Among them, there were 61 reconstruction cases, a skin-sparing mastectomy (SSM) with immediate reconstruction was performed on 29 cases. Of these patients, 15 patients were taken SSM and TRAM flap reconstruction. Our patients selection criteria of SSM was as follows, diffuse DCIS that is not candidates for breast conserving surgery, Paget's disease of the nipple, clinically early breast cancer without skin involvement, and the centrally located cancer that would require removal of the nipple-areolar complex.

All the surgeries performed under these procedures were considered to be successful. All of the TRAM flap and star flap were alive. The main rawback was bleeding, which occurred in 6 patients but was managed by transfusion, The wound seroma occurred in 3 patients and was managed easily by repeated aspiration.

Skin-sparing mastectomy with immediate TRAM and star flap reconstruction gives markedly improved results by reducing the scars on the reconstructed breast, providing a supple breast with a natural ptotic shape, and aesthetically satisfied, We propose more frequent application of this method for the indicated patients, but we need further follow-up of the local recurrence rate and the detection rate in these patients.