Immediate breast reconstruction after mastectomy using a rectus abdominis myodermal flap without an implant.

In the authors' opinion there is no physical reason for a waiting period after total mastectomy before the breast is reconstructed. If the duration of the patient's survival is limited, the sooner the breast is reconstructed the better. The authors do not use silicone implants that may be blamed for the appearance of recurrent tumour but reconstruct the breast with a vertical rectus abdominis myodermal flap immediately after the mastectomy. The flap is an island of skin, fat and muscle extending from the xiphoid to the pubis; it receives its blood supply from the perforators of the superior-inferior epigastric vascular axis on the same side as the mastectomy. The rectus abdominis muscle is the pedicle and carrier of the vessels that feed the ellipse of skin. The flap is doubled on itself and thus forms a cone. It is then passed into the breast area by undermining the intervening bridge of skin. Nipple and areola are grafted onto the flap. This operation enables a wide resection, so that the principles of cancer management are not compromised.