Goals/Purpose: For patients with excessively large or ptotic breasts who are anatomically not candidates for nipple-sparing mastectomy (NSM), we perform a staged mastectomy. In the first stage, a mastopexy or breast reduction is performed, followed by the NSM through the mastopexy incision several weeks to months later.
Methods/Technique: We identified twelve patients who underwent a NSM after a planned or unrelated mastopexy/reduction. Patient demographics, indications for mastectomy, timing of the procedures, and outcomes of the procedure were reviewed.
Results/Complications: Thirteen patients (20 breasts) underwent NSM after mastopexy or reduction. Average length of follow up was one year (12 to 943 days). The procedure was planned in 8 patients (15 breasts) and unplanned, or coincidental, in 5 patients (5 breasts). All patients underwent immediate reconstruction with tissue expanders (11 patients), or implants (2 patients), and acellular dermal matrix was used in all patients. Average time from mastopexy/breast reduction to NSM was 110.6 days in the planned group and 6 years 20 days in the unplanned group. 4 (22%) of the 20 operated breasts experienced a complication. Two patients (3 breasts, 17% ) developed minimal partial nipple necrosis, however no patients lost a significant portion of their nipples due to necrosis. 2 patients (2 breasts, 11%) developed skin flap necrosis. 1 patient (1 breast, 6%) had a device explanted for infection secondary to skin flap necrosis.
Conclusions: Nipple sparing mastectomy in the ptotic and large breast remains a serious challenge with need for further investigation. In carefully selected patients, a staged mastopexy can allow for NSM with acceptable complication rates and good aesthetic outcomes.
3 years post-op
Below: 8 months post-op
Tissue Expanders in place
Marking for NSM through vertical mastopexy incision
Markings for vertical mastopexy