In most situations, a mastectomy is performed though a transverse incision. However, this transverse incision can be problematic when breast reconstruction is attempted. The excess skin and tissue medially and laterally does not usually resolve with expansion and often requires extension of the incision for correction. Furthermore, due to the expansion process, the central area of the reconstructed breast can become very thin and preclude nipple reconstruction.

Since plastic surgeons rely on vertical incisions on the breast mound and horizontal incisions along the inframammary fold to shape the breasts for breast reductions and mastopexies, it was hypothesized that a vertical mastectomy may lead to improve cosmesis after breast reconstruction.

We utilized a vertical mastectomy incision (inverted teardrop) in 25 patients undergoing either therapeutic or prophylactic mastectomies. Nineteen of these patients had bilateral procedures and 6 patients underwent unilateral procedures. All patients underwent immediate breast reconstruction with tissue expanders. All patients successfully completed tissue expansion and 8 (33%) underwent permanent implant placement.

The overall early complication rate (less than 8 weeks) was 28% and the late complication rate (> 8 weeks) was 12%. The most frequent early complication was eschar formation at the superior aspect of the vertical incision (43%). This delayed expansion but did not result in expander extrusion. Two expanders leaked resulting in early exchange for a permanent implant and two expanders were removed “prophylactically” due to concern for a systemic infection.

The majority of patients expressed great satisfaction with the incision as it was not associated with the stigmata of breast cancer. From a surgical standpoint, since the initial incision was in an appropriate position, the skin envelope was easily modified at the time of the permanent implant placement.

In conclusion, we believe the inverted teardrop incision to be safe for breast reconstruction with complication rates comparable to other methods. Although, the rate of eschar formation was higher than expected, it has substantially decreased as we decreased the amount of fluid placed in the expander at the time of surgery. As these patients progress in their reconstruction, we also believe the overall cosmesis of the reconstructed breast will be superior due to the ability to better manage the skin envelope.
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