Aesthetic refinements in prophylactic subcutaneous mastectomy with submuscular reconstruction.

We present a series of 267 patients who have had bilateral prophylactic subcutaneous mastectomies with immediate submuscular reconstruction. Seventy-one of these patients had a simultaneous surgical skin reduction (mastopexy). All 276 patients have both of their implants currently in place and have achieved very satisfactory functional and aesthetic results, as judged by both the patient and the surgeon. We believe the essentials to obtaining a satisfactory result are thorough preoperative evaluation, creation of adequate muscle cover to include always a large triangle of the serratus anterior with the pectoralis and rectus abdominis muscles, proper use of skin taping in patients not undergoing a surgical mastopexy to allow adhesion of the nipple-areola complex in the proper position and shape, and careful postoperative muscle therapy.