doi: 10.1097/PRS.0000000000001325
DellaCroce, Frank J. et al.
Background: Patients with moderate
to severe ptosis are often considered poor candidates for nipple-sparing
mastectomy. This results from the perceived risk of nipple necrosis and/or the
inability of the reconstructive surgeon to reliably and effectively reposition
the nipple-areola complex on the breast mound after mastectomy.
Methods: A retrospective review
identified patients with grade II/III ptosis who underwent nipple-sparing
mastectomy with immediate perforator flap reconstruction and subsequently
underwent a mastopexy procedure. The mastopexies included complete,
full-thickness periareolar incisions with peripheral undermining around the
nipple-areola complex to allow for full transposition of the nipple-areola
complex relative to the surrounding skin envelope.
Results: Seventy patients with 116
nipple-sparing mastectomies met inclusion criteria. The most common
complications were minor incisional dehiscence (7.7 percent) and variable
degrees of necrosis in the preserved breast skin (3.4 percent) after the
initial mastectomy. There were no cases of nipple-areola complex necrosis following
the secondary mastopexy.
Conclusions: The authors demonstrate
that full mastopexy, including a complete full-thickness periareolar incision
and nipple-areola complex repositioning on the breast mound, can be safely
performed after nipple-sparing mastectomy and perforator flap breast
reconstruction. The underlying flap provides adequate vascular ingrowth to
support the perfusion of the nipple-areola complex despite complete incisional
interruption of the surrounding cutaneous blood supply. These findings may
allow for inclusion of women with moderate to severe ptosis in the candidate
pool for nipple-sparing mastectomy if oncologic criteria are otherwise met.
These findings also represent a significant potential advantage of autogenous
reconstruction over implant reconstruction in women with breast ptosis who
desire nipple-sparing mastectomy.
