Table 5.
Table reviewing all of the studies published on nipple-sparing mastectomy in large-volume, ptotic breasts from 1970 to 2016.
| Technique | Reconstruction | Sample size (number of breasts) | Indication | Ptosis/breast volume | Partial NAC necrosis | Total NAC necrosis | Other complications | |
|---|---|---|---|---|---|---|---|---|
| Simultaneous mastopexy and NSM | ||||||||
|
| ||||||||
| Goulian & McDivitt, 1972 | SCM with reduction mastopexy | Implant None |
24 | Risk reduction | Medium-large Not specified |
None | None | Hematoma (NR) |
|
| ||||||||
| Biggs et al., 1977 | SCM with reduction mastopexy | Implant | 33 | NR | Not specified Min-Mod ptosis |
None | None | Partial flap necrosis (1) Capsular contractures (8) Atrophy requiring excision (1) Explant (1) |
|
| ||||||||
| Jarrett et al., 1978 | SCM, reduction mastopexy, and free nipple graft | Implant | 44 | Risk reduction | Large volume Severe ptosis |
None | None | NR |
|
| ||||||||
| Gibson, 1979 | SCM with reduction mastopexy | NR | NR | Risk reduction | Not specified | None | None | NR |
|
| ||||||||
| Rusby & Gui, 2010 | NSM with reduction mastopexy | Expander | 16 | Risk reduction | NR NR |
NR | 6.3% | None |
|
| ||||||||
| Nava et al., 2011 | NSM with reduction mastopexy | Implant | 13 | Therapeutic | NR NR |
NR# | NR# | NR# |
|
| ||||||||
| Rivolin et al., 2012 | NSM with periareolar pexy | Implant | 22 | Therapeutic | Medium-large volume Moderate ptosis |
13.6% | 4.6%∗ | None |
|
| ||||||||
| Al-Mufarrej et al., 2013 | NSM with reduction mastopexy | Expander Implant |
48 | Risk reduction | Large volume Moderate |
8.3% | 4.2% | Infected implant (2.1%) Implant rupture (14.6%) Hematoma (2.1%) Capsular contracture (4.2%) |
|
| ||||||||
| Pontell et al., 2016 (this report) | NSM with reduction mastopexy | Expander DIEP Flap |
16 | Risk reduction Therapeutic |
Large volume Grade II/III ptosis |
0%∗∗ | 0%∗∗ | Hematoma Seroma Mastectomy flap necrosis |
|
| ||||||||
| Staged mastopexy and NSM | ||||||||
|
| ||||||||
| Schneider et al., 2012 | NSM with immediate flap placement and staged reduction mastopexy | TUG Flap DIEP Flap |
34 | NR | Large volume Grade II/III ptosis |
None | 3% | Hematoma (3%) |
|
| ||||||||
| DellaCroce et al., 2015 | NSM with immediate flap placement and staged reduction mastopexy | DIEP Flap SGAP Flap |
110 | Risk reduction Therapeutic |
Medium-large volume Grade II/III ptosis |
None | None | Partial mastectomy flap necrosis (3.6%) Incisional dehiscence (8%) Hematoma (2.7%) Partial flap necrosis (1.8%) |
|
| ||||||||
| Spear et al., 2012 | Reduction mastopexy followed by NSM | Implant Tissue expander |
24 | Risk reduction Therapeutic |
Medium volume Grade II/III ptosis |
12.5% | None | Breast infection (8%) Skin flap necrosis (17%) Explant (4%) |
NAC: nipple-areolar complex; NSM: nipple-sparing mastectomy; SCM: subcutaneous mastectomy; NR: not reported; DIEP: deep inferior epigastric perforator; TUG: transverse upper gracilis; SGAP: superior gluteal artery perforator. #Complications were not stratified by NSM (SRM) versus SSM status. ∗This study mentions the exclusion of one patient who had total NAC necrosis. ∗∗These rates exclude the patients who were smokers, including patients with partial and total NAC necrosis rates of 12.5% and 18.7%, respectively.