Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast: Is Preshaping of the Challenging Breast a Key to Success?

Gudjon L Gunnarsson, Camilla Bille, Laurens C Reitsma, Peter Wamberg, Jørn Bo Thomsen

Research output: Contribution to journalConference articleResearchpeer-review

Abstract

BACKGROUND: Nipple-sparing mastectomy with simultaneous hammock technique direct-to-implant reconstruction is increasingly offered to patients opting for risk-reducing mastectomy. Despite this promising method, patients with macromastia and ptotic breasts remain a challenging group to treat satisfactorily and more often end up undergoing a difficult corrective procedure and experience an unacceptably high rate of failed reconstruction. The authors examined whether targeted preshaping mastopexy/reduction could prepare these patients for a successful nipple-sparing mastectomy/direct-to-implant reconstruction.

METHODS: Patients seeking risk-reducing nipple-sparing mastectomy/direct-to-implant reconstruction at the authors' institutions deemed unfit for a one-stage procedure based on their previous experience were offered a targeted two-stage, risk-reducing mastopexy/reduction followed by a delayed secondary nipple-sparing mastectomy and direct-to-implant reconstruction. Patients were followed up at 3 weeks and 6 or 12 months.

RESULTS: Forty-four reconstructions were performed in 22 patients aged 43 years (range, 26 to 57 years). All 44 procedures were completed successfully without any failure or nipple-areola complex losses. Patients' median body mass index was 30 kg/m (range, 22 to 44 kg/m). Six patients were smokers and one had hypertension. Two patients underwent reoperation because of hematoma and fat necrosis.

CONCLUSIONS: The authors' results demonstrate that a targeted preshaping mastopexy/reduction followed by nipple-sparing mastectomy/direct-to-implant reconstruction can be safely planned in women who opt for a risk-reducing mastectomy and can be performed successfully with a 3- to 4-month time span between operations. On the basis of these results and the superior cosmetic outcome, the two-stage approach has become the authors' standard of care in all such settings.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Original languageEnglish
JournalPlastic and Reconstructive Surgery
Volume140
Issue number3
Pages (from-to)449-454
ISSN0032-1052
DOIs
Publication statusPublished - Sept 2017
EventPlastic Surgery The Meeting 2016 – American Society of Plastic Surgeons Annual Meeting - Los Angeles, United States
Duration: 23. Sept 201627. Sept 2016

Conference

ConferencePlastic Surgery The Meeting 2016 – American Society of Plastic Surgeons Annual Meeting
Country/TerritoryUnited States
CityLos Angeles
Period23/09/201627/09/2016

Keywords

  • Journal Article

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