Tissue Contraction—A New Paradigm in Breast Reconstruction

Hilton Becker, MD, FACS; Olga Zhadan, MD, MS


Plast Reconstr Surg Glob Open. 2018;6(7):e1865 

In This Article


The shift from modified radical mastectomy to skin-sparing and nipple-sparing mastectomy offers new options for immediate breast reconstruction.[1] Tissue expansion is no longer crucial, especially with the advent of prepectoral reconstruction. In fact, with skin-sparing mastectomies, patients may have an excess of skin.[2,3] A Wise pattern reduction type of incision is often used to excise the excess of skin.[4,5] However, this carries the additional risk of vascular compromise and complicated wound healing.[6]

In cases in which a delayed reconstruction is performed, the skin flap contracts, thickens, elevates, and becomes adherent to the underlying muscle (Figure 1). We have noticed that mastectomy flaps will contract in a similar fashion to the size of an underfilled implant, especially when it is partially filled with air. Because air is lighter than saline, there is less pressure exerted on the inferior skin flap. Contraction results in elevation and thickening of the flap, minimizing the need for acellular dermal matrix (ADM). Therefore, instead of performing delayed reconstruction following mastectomy, the adjustable breast implant can be placed virtually empty as a spacer with little to no additional risk of skin flap compromise.

Figure 1.

Patient following skin-sparing mastectomy without reconstruction. Skin flap attaches to the chest wall, contracts, and thickens.

The inherent ability of the skin to contract can be utilized advantageously in immediate breast reconstruction surgery. We present a series of 20 cases in which skin contraction was shown to facilitate breast reconstruction outcomes.