Background:A technique of a free nipple graft with an inframammary incision and no vertical incision offers promising postoperative results as a safe and aesthetic alternative. Methods: This was a retrospective chart review of patients who presented to a single surgeon for breast reduction surgery using a free nipple graft with an inframammary incision from June 1999 to March 2021. Baseline patient demographics and clinical information along with postoperative complications were recorded and compared between patients who presented for concomitant reconstruction or just reduction. A narrative literature review on surgical techniques and outcomes was also conducted. Results: From the literature search, there have been minimal prior mentions of breast reductions using a free nipple graft with an inframammary incision and no vertical incision. Fifty-five cases were identified for breast reduction surgery in the author's 22-year study period, of which 46 had adequate clinical documentation and follow-up. An estimated 22 patients had either both or one breast reconstructed with opposite side breast reduction, and 24 patients underwent breast reduction alone with free nipple grafting. No implants were used in any of the patients. Conclusions:The free nipple graft technique with an inframammary incision can be performed on patients with excessively large or ptotic breasts. It is possible to reduce the volume of the breast and obtain good projection with this method. Furthermore, avoidance of the vertical incision reduces breakdown at the T-junction and is aesthetically beneficial.

Summary: Randomized controlled trials, though considered the gold standard in clinical research, are often not feasible in plastic surgery research. Instead, researchers rely heavily on observational studies, leading to potential issues with confounding and selection bias. Propensity scoring—a statistical technique that estimates a patient’s likelihood of having received the exposure of interest—can improve the comparability of study groups by either guiding the selection of study participants or generating a covariate that can be adjusted for in multivariate analyses. In this study, we conducted a comprehensive review of research articles published in three major plastic surgery journals (Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive, & Aesthetic Surgery, and Annals of Plastic Surgery) to determine the utilization of propensity scoring methods in plastic surgery research from August 2018 to August 2020. We found that propensity scoring was used in only eight (0.8%) of 971 research articles, none of which fully reported all components of their propensity scoring methodology. We provide a brief overview of propensity score techniques and recommend guidelines for accurate reporting of propensity scoring methods for plastic surgery research. Improved understanding of propensity scoring may encourage plastic surgery researchers to incorporate the method in their own work and improve plastic surgeons’ ability to understand and analyze future research studies that utilize propensity score methods.

Background: Although it is intuitive that nipple-sparing mastectomy in selected patients would result in excellent cosmetic outcomes and high patient satisfaction, studies of clinical outcomes and health-related quality of life are limited and show mixed results. This study aimed to use a propensity score–matching analysis to compare satisfaction and health-related quality-of-life outcomes in patients who underwent implant-based reconstruction following bilateral nipple-sparing mastectomy or skin-sparing mastectomy. Methods: A propensity score–matching analysis (1:1 matching, no replacement) was performed comparing patients undergoing nipple-sparing or skin-sparing mastectomy with immediate bilateral implant-based breast reconstruction. Patients with a history of any radiation therapy were excluded. Matched covariates included age, body mass index, race, smoking history, neoadjuvant chemotherapy, bra size, and history of psychiatric diagnosis. Outcomes of interest included BREAST-Q scores and complications. Results: The authors examined 1371 patients for matching and included 460 patients (nipple-sparing mastectomy, n = 230; skin-sparing mastectomy, n = 230) in the final analyses. The authors found no significant differences in baseline, cancer, and surgical characteristics between matched nipple-sparing and skin-sparing mastectomy patients, who also had similar profiles for surgical complications. Interestingly, the authors found that postoperative Satisfaction with Breasts scores and all other health-related quality-of-life domains were stable over a 3-year period and did not differ significantly between the two groups. Conclusions: Compared with skin-sparing mastectomy, bilateral nipple-sparing mastectomy did not improve patient-reported or clinical outcomes when combined with immediate implant-based reconstruction. The impact that nipple-sparing mastectomy may have on breast aesthetics and the ability of the BREAST-Q to gauge an aesthetic result following nipple-sparing mastectomy warrant further investigation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.