Abstract
Introduction
Despite the development of breast-conserving surgery in breast cancer treatment, there
still remain indications for total mastectomy. Since mastectomy has a significant
negative impact on the patients’ quality of life, breast reconstruction is increasingly
popular. However, for patients with large ptotic breasts who do not choose tissue-based
reconstruction techniques and prefer implant-based breast reconstruction, there is
no single-stage breast reconstruction technique other than the classic technique using
Acellular Dermal Matrix (ADM).
Methods
This study presents a novel technique for Nipple-Sparing Mastectomy (NSM) and Immediate
Breast reconstruction (IBR) in 11 operations (in seven patients) whose treatment decision-making
was based on NCCN guidelines. In this technique, the implant/tissue expander is covered
by the pectoral muscle in the upper part and an autologous dermal flap in the lower
part, replacing an ADM. The dermal flap is created from the de-epithelialized lower
mastectomy flap in these large ptotic breasts. Maintaining the nipple-areola complex
(NAC) is possible by re-implanting a free nipple split-thickness graft from the NAC
of the ipsilateral breast prepared at the beginning of the operation.
Results
All seven patients had large ptotic breasts ranging from C cup to double D in size
and grade 2 and higher breast ptosis. The mean BMI of the patients was 28 (range:
26-33). No major complications occurred postoperatively. There were three minor complications,
all managed conservatively. Surgical indications were risk reduction surgery in three
patients with BRCA mutations and therapeutic in the remaining patients (three multifocal
invasive ductal carcinomas and one diffused ductal carcinoma in situ). None of the patients had a previous reduction mammoplasty as preparation for NSM,
and all the patients underwent a single operation. No breast tissue remained under
the NAC, which is ideal with the NSM technique.
Conclusions
The proposed technique is excellent for implant-based IBR in patients with large ptotic
breasts. It eliminates the use of ADM mesh and reduces the cost and postoperative
complication rate associated with ADM. Furthermore, using a free nipple graft technique
can eliminate the need for a preparatory mastopexy. This technique can also theoretically
reduce the risk of recurrence or new primary breast cancer as there are no remaining
ducts beneath the nipple-areola complex.
Keywords
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Article info
Publication history
Published online: November 30, 2022
Accepted:
November 2,
2022
Received in revised form:
September 5,
2022
Received:
May 10,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
