title: Simultaneous mastopexy in patients undergoing prophylactic nipple-sparing mastectomies and immediate reconstruction.
abstract: BACKGROUND
  In some patients, a satisfactory aesthetic result of reconstruction following a nipple-sparing mastectomy (NSM) is limited by breast ptosis that goes uncorrected in the early phase of reconstruction. Most plastic surgeons remain hesitant to perform a mastopexy at the time of NSM due to concerns with nipple and/or skin flap loss.
  
  
  METHODS
  From 1990 to 1995, 33 female patients underwent NSM with simultaneous mastopexy and immediate implant-based reconstruction by a single surgeon at our institution. On chart review, the following data were extracted: age, co-morbidity, indication, breast size, initial/final implant volumes, type of implant, mastopexy technique, mastectomy flap/nipple necrosis, other complications, revision surgery and follow-up. An unpaired, two-tailed t-test was performed where indicated. P-value<0.05 was considered significant.
  
  
  RESULTS
  Wound complications occurred in 18.2% patients (10.9% breasts) without delaying tissue expansion. As many as 3% patients developed unilateral, isolated partial ischaemia of the mastectomy flap and 8% patients developed unilateral, superficial areolar loss. All resolved with conservative treatment. Only one patient developed bilateral total nipple loss. There was no correlation between preoperative breast size and postoperative complications. None of the patients developed breast cancer. Average follow-up was 11.6 years.
  
  
  CONCLUSIONS
  With proper technique, simultaneous mastopexy is a safe procedure in highly selected patients undergoing NSM with reconstruction.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA.
authors.forename: F M
authors.initials: FM
authors.lastname: Al-Mufarrej
authors.forename: J E
authors.initials: JE
authors.lastname: Woods
authors.forename: S R
authors.initials: SR
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009558:Nipples; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013524:Surgical Flaps; D016896:Treatment Outcome