Introduction：In primary breast reconstruction after nipple-sparing mastectomy (NSM)， reconstruction using implants is increasing, but that using autologous tissue also plays an important role. Method：We investigated primary reconstruction cases after NSM using a free deep inferior epigastric perforator flap (free DIEP flap) or pedicled latissimus dorsi myocutaneus flaps (LD). Results：There were 9 cases in which free DIEP flaps were used and 19 cases in which LD were used. Lateral incision was performed in 27 cases. The weight of resected mammary gland tissue was 533 g on average in free DIEP flap cases and 197 g on average in LD cases. Discussion：LD were useful in cases with projection up to 3.0 cm and weight of the resected mammary gland tissue within 200 g in the primary reconstruction after NSM. We were able to reconstruct small breasts and ptotic breasts using free DIEP flaps and LD. In addition, we were able to prevent upward deviation of the nipple-areolar complex, and successfully reconstruct cases with necrosis of the nipple-areolar complex and incision site using free DIEP flaps and LD.

The present study examined changes in methods of antimicrobial prophylaxis in immediate breast reconstruction with a tissue expander (TE) and rates of infection. When this procedure was initially introduced, antimicrobials were only administered once (30 min prior to surgery). The rate of infection at the time was high, at 13.6％. To remedy this situation, antimicrobials were additionally administered every 3 h intraoperatively, and continued postoperatively until Day 7. This approach resulted in no infections (0％). However, postoperative administration of antimicrobials for 7 days was deemed too long based on the guidelines, and the duration was shortened to 3 days. This resulted in a low rate of infection of 1.4％. Antimicrobials must be administered correctly to prevent infection in immediate breast reconstruction with a TE, but postoperative administration for a few days is sufficient. Although this technique involves the use of an implant, excess prophylaxis with antimicrobials should be avoided.