The Role of Pre-Mastectomy Mastopexy And Breast Reduction in the Reconstruction of the Enlarged or Ptotic Breast

The indications for nipple sparing mastectomy (NSM) have broadened over time. Patients undergoing NSM who have enlarged or ptotic breasts are at risk for skin flap and/or nipple and areola complex (NAC) necrosis. Pre-mastectomy mastopexy or breast reduction may reduce the risk for these complications. A retrospective review was undertaken in a series of patients who underwent pre-mastectomy reduction mammaplasty or mastopexy followed by NSM and immediate staged tissue expander (TE)/implant based breast reconstruction. In each case, a sub-nipple biopsy was performed at the pre-mastectomy procedure to clear it of any potential malignant involvement. As well, the area under the areola was undermined to maximize the effect of the delay phenomenon on the eventual survival of the NAC. Final reconstruction involved TE exchange for a permanent implant with associated fat grafting. Data regarding surgical timing and selected postoperative complications were recorded. In total, 39 implant-based reconstructions were performed in 20 patients. There were no cases of mastectomy flap necrosis and partial necrosis of the NAC with delayed wound healing was seen in two breasts in the same patient. All patients eventually completed the reconstructive process successfully. Pre-mastectomy mastopexy or breast reduction may afford a protective effect against mastectomy flap or NAC necrosis in patients with large or ptotic breasts who subsequently undergo nipple-sparing mastectomy with immediate breast reconstruction.