When tumour-adapted reduction mammoplasty has to be ruled out due to the unfavourable ratio of breast to tumour size, some surgeons recommend partial mastectomy and reconstruction using distant flap grafting (latissimus dorsi flaps, TRAM flaps, etc., see TRAM flaps).
We do not consider this approach to be beneficial as with the skin-sparing removal of the entire gland tissue (skin sparing mastectomy) the patient is on the one hand spared the radiotherapy of the remaining breast tissue and on the other hand an equally good aesthetic result can be attained as from a partial mastectomy with reconstruction.
However the decisive factor is that, with a partial mastectomy and reconstruction, a valuable reconstruction procedure for the re-building of the entire breast has been sacrificed. In this special situation and for this reason we recommend a complete skin-sparing mastectomy and immediate reconstruction.