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Mastopexy/Reduction Mammaplasty after Nipple Sparing Mastectomy and Breast Reconstruction Using Autologous Tissue: Is it safe?
Sybile Val, MD.
Louisiana State University, New Orleans, LA, USA.

Mastopexy/Reduction Mammaplasty after Nipple Sparing Mastectomy and Breast Reconstruction Using Autologous Tissue: Is it safe?
Sybile Val, MD and Alireza Sadeghi, MD FACS
Louisiana State University
Division of Plastic and Reconstructive Surgery
New Orleans, LA
Introduction:
Major advances have occurred in the treatment of breast cancer in the last decade. Both breast and plastic surgeons have refined operative techniques to ensure the best oncological and cosmetic result. No longer are patient left with large disfiguring incisions or unnatural reconstruction options.
For the oncological surgeon the nipple-sparing mastectomy (NSM) revolutionized breast cancer treatment just as the buried autologous free flap has revolutionized breast reconstruction. With all of these great advances the question remains can we do more? Are there any other modalities to improve the autologous breast reconstruction?
Results of staged operations (mastopexy/mammoplasty prior to reconstruction) in an attempt to improved cosmetic outcomes are very promising. However, to date there is no literature describing mastopexy techniques following NSM with autologous reconstruction. Thus, we report our experience with “lifting” the autologous reconstructed breast.
Method:
Twenty-two patients with grade one or two ptosis were included in our experience. All had autologous reconstruction with deep inferior epigastric perforator or superficial inferior epigastric artery flaps. Pre-operatively degree of ptosis was recorded. Three months following the NSM and reconstruction, patients had either wise pattern, circumareolar or circumvertical mastopexy. Post-operatively all patients were examined at 2, 4, 6 and 8 weeks, then semi-annually. All complications were documented with particular attention to nipple viability and post-operative degree of ptosis.
Results:
Twenty-two patients (40 reconstructed breasts) underwent autologous reconstruction mastopexy/reduction mammaplasty. All patients in this study underwent a central mound tissue rearrangement and skin tightening using the wise pattern, circumareloar or circumvertical technique. Post-operatively all had non-ptotic breasts. Two patients had minor wound complications (seroma and wound dehiscence) and one patient had partial nipple loss.
Discussion:
The larger breast envelope encountered in patients with ptotic breast presents a challenge to the reconstructive plastic surgeon. Staged breast reduction or mastopexy followed by nipple sparing mastectomy and breast reconstruction has been described in the literature for patients undergoing elective mastectomies for risk reduction. In patients with breast cancer this is not a viable option. NSM can be offered to patients with moderate to severe ptosis with immediate autologous breast reconstruction followed by a staged mastopexy or reduction of the breast. During the time period between the two procedures the blood supply of the nipple is predominantly dependent on the underlying flap and less dependent on the peripheral cutaneous circulation. This allows movement of the nipple based solely on the blood supply of the reconstructed breast.
Conclusion:
Mastopexy of the autologous reconstructed breast performed after nipple sparing mastectomy can be safely performed. The viability of the nipple can be maintained based solely on the vasculature of the free flap.


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