Envelope mastectomy with immediate reconstruction (EMIR)

Aims: To develop an oncologically safe and aesthetically acceptable technique for mastectomy, using a muscle flap and tissue expander through one incision. Methods: Twelve consecutive patients (mean age 40) underwent an envelope mastectomy (skin and nipple sparing), with immediate reconstruction with a latissimus dorsi muscle flap and tissue expander. Assessment of cosmesis was by review of pre- and post-operative photographs by an independent observer. Results: During follow-up there have been no recurrences. Assessment of cosmesis gave a score of 44 out of 48 (92%). One prosthesis was removed due to erosion of the prosthesis through the skin. Conclusions: In patients with large lesions, multi-focal lesions (both invasive and in situ) and recurrent phyllodes tumours may undergo an oncologically safe mastectomy with immediate reconstruction through a single incision that is inconspicuous being in the mid-axillary line. Although follow up is only 8.5 months, long-term studies are being undertaken. (C) 2000 Harcourt Publishers Ltd.