Breast Reconstruction Using a Staged Nipple-Sparing Mastectomy following Mastopexy or Reduction

Abstract

Background: To address those patients who do not meet anatomical criteria for nipple-sparing mastectomy, the authors use a staged approach: (1) mastopexy or breast reduction, (2) nipple-sparing mastectomy through the mastopexy incisions after a minimum of 3 to 4 weeks, and (3) the final reconstruction. Methods: Fifteen patients underwent nipple-sparing mastectomy at Georgetown University Hospital between 2007 and 2010 after planned or unrelated mastopexy or reduction. An institutional review board–approved retrospective chart review recorded demographic information and outcomes such as skin necrosis and device failure. Results: Fifteen patients (24 breasts) underwent nipple-sparing mastectomy after mastopexy or reduction with an average follow-up of 13 months. The staged procedure was planned in 10 patients [19 breasts (79 percent)] and unplanned, or coincidental, in five [five breasts (21 percent)]. The mastectomy was prophylactic in 17 breasts (71 percent) and therapeutic in seven (29 percent). Four of the 24 operated breasts (17 percent) experienced a complication. Two patients [two breasts (8 percent)] developed skin flap necrosis. Two patients [three breasts (13 percent)] developed minimal partial nipple-areola complex necrosis. One patient [one breast (4 percent)] had an expander explanted for infection related to skin flap necrosis. Fourteen patients [23 breasts (96 percent)] successfully recovered following nipple-sparing mastectomy and prior mastopexy or reduction without residual effects of nipple-areola complex or skin flap necrosis. Conclusions: The authors are comfortable offering the staged approach to nipple-sparing mastectomy to patients with moderately large or ptotic breasts. It may not be suitable for the very large or ptotic breast. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.