Because of increased risk for nipple necrosis, many surgeons believe large ptotic breasts to be a relative contraindication to nipple-sparing mastectomy (NSM). A retrospective review was performed on 85 consecutive patients who underwent NSM with 141 immediate perforator free-flap breast reconstructions. We analyzed the subset of patients with large ptotic breasts, defined as cup size C or greater, sternal notch to nipple distance greater than 24 cm and grade 2 or 3 breast ptosis. Of the 85 patients, 19 fit the inclusion criteria. Breast cup size ranged from 34C to 38DDD. There was 1 case of nipple necrosis in the patient with previous breast radiation (5%), 1 hematoma (5%), and no flap losses. Five (26%) patients underwent subsequent mastopexy or breast reduction, a mean of 6.6 months after the primary procedure. We demonstrate that NSM and free-flap breast reconstruction can be safely and reliably performed in selected patients.
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http://dx.doi.org/10.1097/SAP.0b013e31824a45be | DOI Listing |
Plast Reconstr Surg
September 2024
Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI.
Background: Multiple skin-sparing incisions are utilized in immediate post-mastectomy breast reconstruction; however, the Wise pattern incision (WPI) may have superior cosmetic outcomes for large ptotic breasts compared to non-Wise pattern incisions (NWPI). We evaluated patient demographics and surgical outcomes with WPI versus NWPI.
Methods: An electronic medical record search was performed for patients at a single academic institution from 2019 to 2022 with ICD-10-CM diagnosis code "Z42.
Gland Surg
July 2024
Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Darlinghurst, NSW, Australia.
Background: Immediate autologous reconstruction after nipple-sparing mastectomy (NSM) is challenging in the ptotic breast due to the large skin envelope and reduced vascular supply to the nipple areolar complex (NAC). Patients with significant ptosis who want to preserve their NACs are often advised to undergo a two-stage procedure: first, a mammoplasty is performed to lift the NAC, and second, a delayed NSM with autologous reconstruction is performed. Unfortunately, patients with active cancer cannot delay their mastectomy; as such, they are often treated with skin-sparing mastectomy (SSM) instead.
View Article and Find Full Text PDFEur J Surg Oncol
October 2024
Surgical Oncology Unit, Alexandria Faculty of Medicine, University of Alexandria, Egypt.
Background: Goldilocks mastectomy represents a midway solution for breast reconstruction between flat chest and sophisticated reconstructive techniques. The literature lacks a standardization of the technique. In this study, we present a step-by-step approach with modifications in the original technique achieving better breast shape and contour within the context of standardization of the technique.
View Article and Find Full Text PDFCase Reports Plast Surg Hand Surg
August 2024
Plastic Surgery Unit, University Hospital Trust of Sassari, Sassari, Italy.
Direct-to-implant (DTI) breast reconstruction after skin reducing mastectomy in large and ptotic breast is characterized by a high rate of complication. The Dermal Sling is commonly used to give extra coverage to the lower pole of the mammary implant to lower the risk of implant exposure in case of wound dehiscence at the T-junction. The aim of the paper is to detail an original technique that combines an inferior dermal sling with pectoral and serratus fascial flaps, to create a pre-pectoral pouch.
View Article and Find Full Text PDFAnn Plast Surg
August 2024
Department of Reconstructive & Plastic Surgery, NYU Langone Health, New York, NY.
Breast ptosis presents challenges for implant-based reconstruction due to the large skin envelope. Skin-reducing mastectomy reduces the envelope but must consider many other factors including complications. Limited data exist on incision impact on outcomes.
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