title: Nipple-sparing mastectomy and immediate free-flap reconstruction in the large ptotic breast.
abstract: 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.
authors.affiliation: Institute of Reconstructive Plastic Surgery, Department of Plastic Surgery, New York University Langone Medical Center, New York Eye & Ear Infirmary and Lenox Hill Hospital, New York, NY 10016, USA.
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Schneider
authors.forename: Constance M
authors.initials: CM
authors.lastname: Chen
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Stolier
authors.forename: Richard L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Ahn
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Allen
mesh_terms: D000328:Adult; D001940:Breast / Q000033:anatomy & histology / Q000601:surgery; D001943:Breast Neoplasms / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D061525:Perforator Flap / Q000637:transplantation*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome