Thierry Tondu1,2, Filip Thiessen1,2, Guy Hubens1, Wiebren Tjalma2,3, Phillip Blondeel4, Veronique Verhoeven5. 1. Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium. 2. Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium. 3. Department of Obstetrics and Gynecology, Antwerp University Hospital, Antwerp, Belgium. 4. Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium. 5. Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Abstract
Background: Large and ptotic breasts are considered an anatomical contraindication for nipple sparing mastectomy (NSM). Necrosis rates can be as high as 76%. The authors examined whether targeted preshaping mastopexy/reduction combined with simultaneous two-stage preshaping of the implant pocket prepares for an uneventful implant reconstruction. Methods: Macromastia and ptosis patients opting for risk-reducing NSM or having a peripherally localized carcinoma in situ, were offered a two-stage mastopexy/reduction simultaneously with preshaping of the implant pocket by subpectoral expansion. Only the inferior pedicle bearing the nipple-areola complex (NAC), remained. A delayed secondary NSM and tissue expander-to-implant reconstruction was scheduled 3 months later. The use of an acellular dermal matrix (ADM) was not necessary because the capsule around the expander created a hammock supporting the definite prosthesis. Follow up was at 2 weeks, 3 months, and 6 months. Results: Forty-one procedures were performed in 24 patients. The mean age was 45±12.08 years (range, 22 to 72 years). Patients' mean body mass index (BMI) was 26.79 kg/m2 (range, 19 to 35 kg/m2). One patient had diabetes and two smoked. One transient epidermolysis of the NAC occurred in each stage. No NAC or skin necrosis occurred; no implant had to be removed. Conclusions: A two-stage mastopexy/reduction, simultaneously with preshaping of the implant pocket by tissue expansion and followed by a 3-month delayed secondary NSM with tissue expander-to-implant reconstruction is a safe technique in large ptotic breasts. 2022 Gland Surgery. All rights reserved.
Background: Large and ptotic breasts are considered an anatomical contraindication for nipple sparing mastectomy (NSM). Necrosis rates can be as high as 76%. The authors examined whether targeted preshaping mastopexy/reduction combined with simultaneous two-stage preshaping of the implant pocket prepares for an uneventful implant reconstruction. Methods: Macromastia and ptosis patients opting for risk-reducing NSM or having a peripherally localized carcinoma in situ, were offered a two-stage mastopexy/reduction simultaneously with preshaping of the implant pocket by subpectoral expansion. Only the inferior pedicle bearing the nipple-areola complex (NAC), remained. A delayed secondary NSM and tissue expander-to-implant reconstruction was scheduled 3 months later. The use of an acellular dermal matrix (ADM) was not necessary because the capsule around the expander created a hammock supporting the definite prosthesis. Follow up was at 2 weeks, 3 months, and 6 months. Results: Forty-one procedures were performed in 24 patients. The mean age was 45±12.08 years (range, 22 to 72 years). Patients' mean body mass index (BMI) was 26.79 kg/m2 (range, 19 to 35 kg/m2). One patient had diabetes and two smoked. One transient epidermolysis of the NAC occurred in each stage. No NAC or skin necrosis occurred; no implant had to be removed. Conclusions: A two-stage mastopexy/reduction, simultaneously with preshaping of the implant pocket by tissue expansion and followed by a 3-month delayed secondary NSM with tissue expander-to-implant reconstruction is a safe technique in large ptotic breasts. 2022 Gland Surgery. All rights reserved.
Entities:
Keywords:
Nipple sparing mastectomy (NSM); breast preshaping; delayed breast reconstruction; nipple delay; nipple necrosis
Authors: Frank J DellaCroce; Craig A Blum; Scott K Sullivan; Alan Stolier; Chris Trahan; M Whitten Wise; Dustin Duracher Journal: Plast Reconstr Surg Date: 2015-07 Impact factor: 4.730