A New Approach to Nipple-sparing Mastectomy and Reconstruction in the High Risk Ptotic Patient

Schwartz, Jean-Claude D.

doi:10.1097/gox.0000000000001779

Cited by 8 publications

(8 citation statements)

References 6 publications

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“…The patients successfully completed all four stages of reconstruction and no instances of implant loss were recorded. 47 With a multiple-staged approach that ensures a well-perfused skin envelope and optimal nipple position prior to implant placement, even patients in this highrisk ptotic patient population remain candidates for NSM.…”

Section: Considerations For the Ptotic Breastmentioning

confidence: 99%

Implant Reconstruction in Nipple Sparing Mastectomy

Chu

Davis

Abu‐Ghname

et al. 2019

Seminars in Plastic Surgery

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Nipple sparing mastectomy has been popularized in the modern era of breast cancer treatment due to its touted advantages with regard to resultant body image and reconstructive outcome. Implant-based techniques remain the most prevalent means of breast reconstruction. Special considerations regarding patient selection and technique are reviewed for implant reconstruction in the setting of mastectomy with nipple preservation. Applications for prepectoral and direct-to-implant reconstruction are discussed and published outcomes are summarized.

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Section: Considerations For the Ptotic Breastmentioning

confidence: 99%

Implant Reconstruction in Nipple Sparing Mastectomy

Chu

Davis

Abu‐Ghname

et al. 2019

Seminars in Plastic Surgery

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“…These techniques offer patients with ptosis, who are usually not considered ideal candidates for NSM, the aesthetic and psychological benefits associated with preservation of the NAC, in a single stage. Techniques to preserve the NAC in ptotic breasts would otherwise involve multiple stages, incorporating reduction or mastopexy [12][13][14] or delay procedures. 15,16 A Wise pattern incision, incorporating an inferior de-epithelialized dermal flap, can be used in patients with ptosis.…”

Section: Discussionmentioning

confidence: 99%

“…10 Currently, the absence of tumor involvement of the NAC has been suggested to be the most important clinical oncologic characteristic in selecting patients for NSM. 11 To minimize the risk of NAC necrosis, implant-based breast reconstruction after NSM in patients with ptosis is generally performed in conjunction with a staging mastopexy or reduction, [12][13][14] or a delay procedure involving prior devascularization of the NAC and mastectomy skin. 15,16 To offer immediate nipple-preserving reconstructions to our patients, a technique previously used by our team preserved the nipple on an inferior dermal pedicle based along the inframammary fold.…”

mentioning

confidence: 99%

Outcomes Using Two Unique Methods of Immediate Implant-Based Breast Reconstruction After Nipple-Sparing Mastectomy in Ptotic Patients

Erlichman¹,

Buro²,

Waraich³

et al. 2023

Ann Plast Surg

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Objective After nipple-sparing mastectomy (NSM) and immediate implant-based reconstruction, patients with significant ptosis are at increased risk for nipple-areolar complex (NAC) necrosis. Attempts to salvage the nipple using inferior dermal pedicles have yielded unsatisfactory results. This study aims to evaluate complications using 2 unique methods of breast reconstruction using either a Wise incision with dermal infolding or batwing incision after NSM. Materials and Methods A retrospective chart review was conducted on all patients who underwent NSM and immediate implant reconstruction using the methods described by a single surgeon between 2016 and 2022. Outcomes were assessed by comparing average complications rates. Result Seventy-three reconstructions were performed after NSM in patients with ptosis. Sixteen reconstructions used a prior technique, Wise pattern with inferior dermal flap. Thirty reconstructions used the Wise incision with dermal infolding, while 27 other reconstructions used a batwing incision. For the Wise with inferior dermal flap technique, NAC necrosis occurred in 43.8%. In the cases in which the newer techniques were used, NAC necrosis occurred in 11.1% in the batwing group and 10% in the dermal infolding group. Other complications measured were within acceptable percentiles between both groups. Aesthetic outcomes were acceptable for most of the cases involving NAC necrosis. Conclusions A batwing pattern incision or a Wise pattern with a broad, infolded dermal pedicle is a more effective method of immediate reconstruction after NSM in patients with ptosis according to these findings. Nipple-areolar complex necrosis continues to be a major complication that is important to discuss with patients. However, these methods offer patients with ptosis the benefit of preserving a native NAC while allowing for simultaneous skin reduction during an immediate reconstruction.

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“…Nipple-areolar preservation in the ptotic population is another domain receiving increased emphasis. To improve cosmesis in grade II and III ptosis, staged techniques for nipple-sparing mastectomy have been described by several authors (56)(57)(58). In 2012, Spear described a threestage approach to spare the NAC in which women first underwent an oncoplastic mastopexy/reduction, followed by a completion mastectomy through the mastopexy incisions, and then the final reconstruction with a prosthesis (59).…”

Section: Ptosismentioning

confidence: 99%

“…In response to this, Schwartz et al developed an alternative staged technique suitable for both multicentric and isolated cancers, even in high-risk patients. Patients would first undergo NSM via a limited lateral incision, completion Wise pattern incision in the office 10 days later, operative repositioning of the skin and NAC two weeks later, and final prosthetic placement with acellular dermal matrix at 3 months (56). In both methods, the skin-reduction techniques are also useful in unilateral breast cancer reconstructions, because the same pattern can be applied to the contralateral side for symmetry (50,51,60).…”

Section: Ptosismentioning

confidence: 99%

Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

Roubaud¹,

Carey²,

Vartanian³

et al. 2021

Gland Surg

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Breast reconstruction is an important part of the cancer treatment paradigm and the psychosocial benefits are well described in the literature. Notably, breast reconstruction restores both the functional and emotional losses patients experience due to tumor resection. Post-cancer quality of life is an important benchmark of successful treatment; therefore, breast reconstruction is an essential component that should be offered whenever possible. Over time, reconstructive techniques and outcomes have improved dramatically resulting in better patient safety and decreased operative morbidity. When counseling a patient for surgery, the provider must consider all aspects of a patient's health. Ideally, breast cancer patients should be physically, emotionally, and oncologically appropriate candidates for reconstruction. However, in concerted effort to provide opportunities for as many patients as possible, the definition of who is a good candidate for reconstruction has evolved to include higher risk patients. These patients include those with advanced age, nicotine use, obesity, and significant ptosis. With improvements in surgical procedures and perioperative care, this population may also benefit from restorative surgery. However, the exact risk of complications and necessary counseling has gone largely undefined in this population. This article examines particular "highrisk" groups that may be challenging for extirpative and reconstructive surgeons and offers current guidelines for practice.

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A New Approach to Nipple-sparing Mastectomy and Reconstruction in the High Risk Ptotic Patient

Cited by 8 publications

References 6 publications

Implant Reconstruction in Nipple Sparing Mastectomy

Implant Reconstruction in Nipple Sparing Mastectomy

Outcomes Using Two Unique Methods of Immediate Implant-Based Breast Reconstruction After Nipple-Sparing Mastectomy in Ptotic Patients

Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

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