INTRODUCTION: Nipple sparing mastectomy (NSM) with simultaneous hammock technique straight to implant reconstruction (SIR) is a good method for the reconstruction of risk reduction patients. In spite of the promising method, patients with macromastia and severely malformed breasts remain a challenging group to treat satisfactorily and more often end up having a difficult corrective procedure and unacceptably high rate of failed reconstruction. The aim of this study was to examine if pre-shaping Mastopexy/reduction followed by a delayed NSM/SIR would be a beneficial approach in these challenging cases.
MATERIALS AND METHODS: Patients seeking risk reducing NSM/SIR at our institutions deemed unfit for a one stage procedure based on our previous experience1 were offered a targeted two stage risk reducing mastopexy/reduction followed by a delayed secondary NSM and SIR. 40 reconstructions were performed in 20 patients aged 43 years (26–57). We registered comorbidities and risk factors, size and shape of ADMs and implants used, the time span from mastopexy to NSM/SIR, time to follow-up, partial or total nipple necrosis and infection, hematoma, skin necrosis and wound dehiscence and reconstruction outcome results.
RESULTS: Reconstruction was achieved without any failure or NAC losses in all 40/40 breasts, 20 bilateral targeted two stage risk reducing mastopexy/reduction and NSM/SIR procedures. Patients median BMI was 30(22–44). Six patients were smokers and one had hypertension. Anatomical shaped silicone implants were used in all cases, average size 555 cc, (310 to 690). Average OR time for NSM/SIR was 125 minutes (90 to 235). The median time between procedures was 133days (105–266). Two patients had a re-operation due to hematoma and fat necrosis. Five patients had minor complications. The median follow-up is currently 220 days (30 to 602).
CONCLUSION: Targeted preshaping mastopexy/reduction of the large, ptotic and deformed breast prior to NSM/SIR has proven to be a successful method to overcome the drawbacks of the procedure for this challenging group of patients. It can be planned and performed safely with a time span of three to four months between surgeries. It appears that the nipple areola complex is pre-conditioned by this two stage approach as we did not experience any vascular compromise or necrosis of the NAC, even in high risk patients.
DISCLOSURE/FINANCIAL SUPPORT: None
1. Gunnarsson GL, Børsen-Koch M, Arffmann S, et al. Successful breast reconstruction using acellular dermal matrix can be recommended in healthy non-smoking patients. Dan Med J 2013;60:A4751.