by Kadakia, Nikita; Kubiak, Jeremy W.; Landau, Mark J.;
Mohiuddin, Waseem; Lewis, Priya G.; Kim, Hahns Y.
Plastic and Reconstructive Surgery: September
2022 - Volume 150 - Issue 3 - p 487-495
Background:
Historically, many patients with breast ptosis have been
excluded from nipple-sparing mastectomies. By performing mastopexy at the time
of immediate reconstruction, more patients with breast ptosis can be considered
for nipple-sparing mastectomies. The authors review their experience of
simultaneous batwing mastopexy performed at the time of immediate implant-based
reconstruction.
Methods:
Using retrospective chart review, the authors identified
patients who underwent immediate implant-based breast reconstruction from 2015
through 2020 at a single institution. The patients were divided into two
cohorts—batwing mastopexy and standard reconstruction (no mastopexy)—and
compared.
Results:
A total of 324 breast operations in 188 patients were
included (80 concurrent batwing and 244 standard implant-based
reconstructions). Patient characteristics were similar between the groups,
except that patients in the batwing group had greater ptosis and more patients
in the standard group underwent adjuvant chemotherapy. Mean follow-up was 15.9 months
(range, 3.19 to 55.20 months). Complication rates were comparable in the
batwing and standard groups, with no statistically significant differences in
rates of hematoma (1.3 versus 3.3 percent; = 0.34), seroma (5.0 versus 8.2
percent; p = 0.34), major infection (8.8 versus 9.0 percent; p = 0.94),
skin or nipple necrosis (6.3 versus 11.5 percent; p = 0.18), or
explantation (11.3 versus 14.8 percent; p = 0.43). The rate of minor
infections was higher in the group with concurrent batwing mastopexy (10.0 versus
3.7 percent; p = 0.03).
Conclusions:
The authors demonstrate that simultaneous batwing mastopexy
can be performed safely at the time of immediate breast reconstruction. This
technique provides comparable complication rates, improves aesthetic outcomes
in patients with significant ptosis or macromastia, and allows nipple-sparing
mastectomy to be an option for those who would otherwise be excluded.
