Background: Several studies have confirmed the reliability of skin-sparing mastectomy in patients who have previously undergone lumpectomy and radiation. However, the safety and efficacy of skin-sparing mastectomy following radiation and prior reduction mammaplasty has not been addressed.

Methods: Eleven consecutive patients from 2001 to 2005 undergoing skin-sparing mastectomy and immediate reconstruction with a previous history of local irradiation and breast reduction mammaplasty were evaluated. Ages ranged from 38 to 75 years ( mean: 51 years).

Results: Nine patients had failed breast conservation therapy. Two patients developed a new primary cancer. All patients were reconstructed with a unipedicled transverse rectus abdominis myocutaneous (TRAM) flaps. Flap survival was 100%. Three patients developed partial-thickness mastectomy flap loss, which was managed conservatively. One patient experienced full-thickness mastectomy skin loss (4 X 4 cm), resulting in split tkickness skin grafting. All patients remain disease-free an average of 31 months (range: 11-54 months) postoperatively.

Conclusions: In summary, skin-sparing mastectomy can be safely performed in patients who have undergone breast irradiation and prior bread reduction mammaplasty. The presence of a well-vascularized tissue bed in the form of immediate autologous tissue breast reconstruction (TRAM flap) promotes healing and minimizes the need for further operative intervention when partial skin loss occurs.