title: Nipple-Sparing Mastectomy and Ptosis: Perforator Flap Breast Reconstruction Allows Full Secondary Mastopexy with Complete Nipple Areolar Repositioning.
abstract: BACKGROUND
  Patients with moderate to severe ptosis are often considered poor candidates for nipple-sparing mastectomy. This results from the perceived risk of nipple necrosis and/or the inability of the reconstructive surgeon to reliably and effectively reposition the nipple-areola complex on the breast mound after mastectomy.
  
  
  METHODS
  A retrospective review identified patients with grade II/III ptosis who underwent nipple-sparing mastectomy with immediate perforator flap reconstruction and subsequently underwent a mastopexy procedure. The mastopexies included complete, full-thickness periareolar incisions with peripheral undermining around the nipple-areola complex to allow for full transposition of the nipple-areola complex relative to the surrounding skin envelope.
  
  
  RESULTS
  Seventy patients with 116 nipple-sparing mastectomies met inclusion criteria. The most common complications were minor incisional dehiscence (7.7 percent) and variable degrees of necrosis in the preserved breast skin (3.4 percent) after the initial mastectomy. There were no cases of nipple-areola complex necrosis following the secondary mastopexy.
  
  
  CONCLUSIONS
  The authors demonstrate that full mastopexy, including a complete full-thickness periareolar incision and nipple-areola complex repositioning on the breast mound, can be safely performed after nipple-sparing mastectomy and perforator flap breast reconstruction. The underlying flap provides adequate vascular ingrowth to support the perfusion of the nipple-areola complex despite complete incisional interruption of the surrounding cutaneous blood supply. These findings may allow for inclusion of women with moderate to severe ptosis in the candidate pool for nipple-sparing mastectomy if oncologic criteria are otherwise met. These findings also represent a significant potential advantage of autogenous reconstruction over implant reconstruction in women with breast ptosis who desire nipple-sparing mastectomy.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: New Orleans, La. From the Center for Restorative Breast Surgery; and St. Charles Surgical Hospital.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: DellaCroce
authors.forename: Craig A
authors.initials: CA
authors.lastname: Blum
authors.forename: Scott K
authors.initials: SK
authors.lastname: Sullivan
authors.forename: Alan
authors.initials: A
authors.lastname: Stolier
authors.forename: Chris
authors.initials: C
authors.lastname: Trahan
authors.forename: M Whitten
authors.initials: MW
authors.lastname: Wise
authors.forename: Dustin
authors.initials: D
authors.lastname: Duracher
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000033:anatomy & histology* / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D061525:Perforator Flap; D012189:Retrospective Studies