Nipple-Sparing Mastectomy and Immediate Free-Flap Reconstruction in the Large Ptotic Breast

Schneider, Lisa; Chen, Constance M.; Stolier, Alan; Shapiro, Richard L.; Ahn, Christina Y.; Allen, Robert J.

doi:10.1097/sap.0b013e31824a45be

Cited by 27 publications

(24 citation statements)

References 14 publications

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“…10,[15][16][17][18] Mastectomy skin flap necrosis rates also vary widely, from 4% to 23%. 10,11,15,17,19,20 Some authors advocate either delay of the NAC to minimize NAC necrosis 21 or banking of skin on the flap beneath the NAC to allow for subsequent replacement of the NAC skin if NAC debridement is necessary.…”

Section: Discussionmentioning

confidence: 98%

Approaches to Microvascular Breast Reconstruction After Total Skin-Sparing Mastectomy

Raghavan¹,

Peled²,

Hansen³

et al. 2015

Annals of Plastic Surgery

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Section: Discussionmentioning

confidence: 98%

Approaches to Microvascular Breast Reconstruction After Total Skin-Sparing Mastectomy

Raghavan¹,

Peled²,

Hansen³

et al. 2015

Annals of Plastic Surgery

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“…Nevertheless, several studies have reported options for women with large breasts and/or advanced ptosis who meet criteria for NSM [1, 13]. These techniques can be broadly subdivided into staged NSM and reduction mastopexy [1, 13, 23] or simultaneous reduction mastopexy with NSM [10, 16–21]. …”

Section: Discussionmentioning

confidence: 99%

“…Review of the literature revealed three studies that focused on staged reduction mastopexy and NSM for women with large, ptotic breasts [1, 13, 23]. Spear et al published a series of cases in which such patients were offered staged NSM and reduction mastopexy [13].…”

Section: Discussionmentioning

confidence: 99%

“…While results were promising, the authors felt this procedure would be best suited for patients with medium-volume breasts with moderate ptosis [13]. Two other studies employed the use of immediate flap-based reconstruction after NSM with a delayed reduction mastopexy [1, 23]. These studies used various free flaps to support NAC perfusion after NSM, and reduction mastopexy for moderately to severely ptotic breasts was performed on a later date [1, 23].…”

Section: Discussionmentioning

confidence: 99%

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Single Stage Nipple-Sparing Mastectomy and Reduction Mastopexy in the Ptotic Breast

Pontell

Saad

Brown

et al. 2018

Plastic Surgery International

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Purpose Given the proposed increased risk of nipple-areolar complex (NAC) necrosis, nipple-sparing mastectomy (NSM) is generally not recommended for patients with large or significantly ptotic breasts. NAC preserving strategies in this subgroup include staged or simultaneous NSM and reduction mastopexy. We present a novel approach towards simultaneous NSM and reduction mastopexy in patients with large, ptotic breasts. Methods Literature pertaining to NSM for women with large, ptotic breasts was reviewed and a surgical approach was designed to allow for simultaneous NSM and reduction mastopexy in such patients. Results Eight patients underwent bilateral NSM with simultaneous reduction mammaplasty and immediate reconstruction. The majority of breasts demonstrated advanced ptosis (69% grade III, 31% grade II) and the average breast volume excised was 760 grams. In those patients without a history of smoking, NAC necrosis rates were 0%. In those patients with a history of smoking, 83% of breasts experienced NAC necrosis (60% total, 40% partial). One hundred percent of patients who smoked experienced some degree of NAC necrosis. Among breasts with grade II versus grade III ptosis, NAC necrosis rates were roughly equal. Conclusions Historically, patients with large, ptotic breasts were excluded from NSM due to the proposed increased risk of NAC necrosis. This study demonstrates a safe approach towards NSM and reduction mastopexy using an inferior, wide-based, epithelialized pedicle. While all patients eventually achieved satisfactory results, there was an association between smoking and NAC necrosis. Smoking cessation is paramount to the operation's success.

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“…In Western countries, reports on reduction mammaplasty and mastopexy for the contralateral breast after unilateral breast reconstruction are fairly numerous (7)(8)(9)(10)(11)(12)(13)(14). Touch-up surgery for contralateral breasts has been rarely reported in Japan.…”

Section: Discussionmentioning

confidence: 99%

Reduction mammaplasty and mastopexy for the contralateral breast after reconstruction surgery following cancer resection: A report of 3 cases

et al. 2016

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Summary : Background : Breast reconstruction generally involves autologous tissue transplantation and placement of a mammary prosthesis. When the patient's breasts are extremely large and ptotic, breast reconstruction often results in significantly asymmetrical appearance. However, a good aesthetic outcome after reconstruction surgery following cancer resection is an important quality-of-life factor. We evaluated the efficacy of touch-up surgery, either reduction mammaplasty or mastopexy, performed on the contralateral breast for symmetrization. Methods : Reduction mammaplasty was performed on the contralateral breast in 2 patients and mastopexy was performed on the contralateral breast in 1 patient after reconstruction surgery following cancer resection, between 2008 and 2014. We reviewed each patient's medical record for general clinical information and for the methods of breast cancer resection and breast reconstruction used, wait time between breast cancer resection and touch-up surgery, preservation of the sensitivity of the nipple-areola complex after the touch-up surgery, and aesthetic outcome (based on visual analog scale score). Results : Wait times in the 3 cases were 4, 9, and 18 months. Nipple-areolar sensitivity was well preserved in all 3 cases. Aesthetic outcomes were judged "excellent" or "very good." Conclusion : Revision surgery on the contralateral breast 4 to 18 months after breast reconstruction substantially improves the aesthetic outcome.

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Nipple-Sparing Mastectomy and Immediate Free-Flap Reconstruction in the Large Ptotic Breast

Cited by 27 publications

References 14 publications

Approaches to Microvascular Breast Reconstruction After Total Skin-Sparing Mastectomy

Approaches to Microvascular Breast Reconstruction After Total Skin-Sparing Mastectomy

Single Stage Nipple-Sparing Mastectomy and Reduction Mastopexy in the Ptotic Breast

Reduction mammaplasty and mastopexy for the contralateral breast after reconstruction surgery following cancer resection: A report of 3 cases

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