Prophylactic mastectomy with immediate reconstruction for the high-risk woman.

Prophylactic mastectomy should provide the woman at high risk for breast cancer with some degree of assurance that the surgical procedure is of benefit in preventing the occurrence of cancer. The so-called subcutaneous mastectomy fails because too much breast parenchyma is left to preserve the blood supply to the undisturbed nipple-areola complex. The procedure of choice described here removes the nipple-areola complex, thins and cores it, and replaces it as a free graft when the breast parenchyma is removed. A high-profile silicone breast implant is inserted into a pocket made of pectoralis major muscle, serratus anterior muscle, and a deepithelialized skin flap.