Scarless Breast Reconstruction: Indications and Techniques for Optimizing Aesthetic Outcomes in Autologous Breast Reconstruction

Abstract

Breast reconstruction that leaves no visible scars on the breast is possible for a subset of patients. This article reviews a cohort of 10 patients who underwent 14 autologous breast reconstructions. To achieve a reconstruction without visible breast scars, the mastectomy and autologous reconstruction are carried out through a periareolar incision. At the completion of the reconstruction, a small skin paddle is externalized through the mastectomy incision and in a subsequent stage entirely incorporated into a nipple areola reconstruction. Following completion of the breast and nipple areola reconstruction, a tattoo is performed that extends beyond the perimeter of the reconstructed areola and conceals all scars on the breast mound. The ideal candidate for this technique has a small or medium size breast, which is non- or minimally ptotic, and a donor site that can yield a flap larger than the volume of the native breast. In properly selected patients, this technique consistently yields high-quality results, which match or even surpass the aesthetics of the original breast.

Fig. 1.

Pre- and postoperative patient photographs. A, Preoperative view of a patient who is indicated for a bilateral mastectomy. Breasts demonstrate minimal ptosis and moderate volume. The mastectomy weight in this case was 596 g on the left and 551 g on the right. B, Completed breast reconstruction following 2 surgical stages and nipple areola tattoo. The tattoo extends beyond the border of the areola resulting in no visible scars on the reconstructed breasts.

Fig. 2.

Preoperative and intermediate stage patient photographs. A, Preoperative view of a patient who is indicated for a bilateral mastectomy with markings for planned incisions. B, Following completion of the first stage of breast reconstruction with bilateral DIEP flaps. The flap weight in this case was 685 g on the left and 672 g on the right, which exceeds the mastectomy weights by approximately 100 g per breast. The mastectomy skin purse strings around a small skin paddle. C, Immediately following completion of breast reconstruction revision, fat grafting and nipple areola reconstruction. The mastectomy skin further purse strings around a 38 mm reconstructed areola. Mastectomy skin is initially pleated around the areola, which resolves over time.