Envelope mastectomy and immediate reconstruction (EMIR), improving outcome without oncological compromise

To determine the long term oncological safety and aesthetic acceptability of envelope mastectomy and immediate reconstruction (EMIR). A retrospective review of 71 cases was carried out. Oncological assessment was by clinical examination, mammography, ultrasound, and, where indicated, MRI scan. Aesthetic assessment was based on detailed clinical examination as well as subjective self-assessment of the outcome. During follow-up (mean 48 months), there were three local recurrences, only one involving the nipple-areolar complex. The mean aesthetic score was 0.75 (out of 1), representing a good aesthetic outcome and patient satisfaction. Nipple-areolar complex preservation is a safe option and EMIR produced a good aesthetic outcome, which is oncologically safe. Furthermore, it does not preclude post-operative radiotherapy.