Breast Reconstruction Using a Staged Nipple-Sparing Mastectomy following Mastopexy or Reduction

Spear, Scott L.; Rottman, Steven J.; Seiboth, Laura; Hannan, Catherine

doi:10.1097/prs.0b013e318241285c

Cited by 127 publications

(131 citation statements)

References 26 publications

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“…According to the authors, the addition of the two staged incisions recreates the Wise pattern, breaking up the T point into two straightforward primary closures. Similarly, Spear et al [61] reported a successful two-stage NSM in 15 patients (24 breasts). All patients underwent NSM after mastopexy or reduction (71% prophylactic and 29% therapeutic) with an average follow-up of 13 mo.…”

Section: Two-stage Approachmentioning

confidence: 99%

“…Thus, the main objective in these sub-group of patients is to preserve the oncological objective of the NSM (therapeutic or risk reduction) while expanding the aesthetic outcome and minimizing complications. For this objective, some authors divided the onestage Wise-pattern skin excision into a two-stage procedure [61,63,64] . In the first stage, the mastopexy or reduction mammoplasty is performed, keeping periareolar dermis preserved to maintain the adequate NAC blood supply at the time of the future definitive NSM.…”

Section: Two-stage Approachmentioning

confidence: 99%

“…Introduced by Spear et al [61] the NSM staged procedure includes patients with large or ptotic breasts and candidates to NAC preservation. In fact, the authors observed that although there are breasts that are too large to be considered for a NSM, it is possible to extend the indications by using the two stage approach and reducing the breast volume and ptosis previously.…”

Section: Two-stage Approachmentioning

confidence: 99%

“…In the greater part of the clinical series, NSM are related to patients with relatively small, minimally ptotic breasts or for risk reduction [14,39,61,62] . However, the NSM reconstruction of large and/or ptotic breasts poses a more troublesome challenge than the NSM of small sized breasts because of an excessively large skin flap [33] .…”

Section: Two-stage Approachmentioning

confidence: 99%

“…Timing: One stage x two stage approach NSM may be planned in one setting with immediate reconstruction (one-stage approach) [39,57,60] , or in two settings with partial glandular resection or NAC autonomization followed by additional breast tissue resection and total reconstruction weeks to months afterwards (two-stages approach) [30,34,39,[61][62][63][64][65] . Preoperative planning should include the breast ptosis and volume and mostly addressing singular reconstructive requirements, enabling each patient to receive an individual "custom-made" planning.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Munhoz

Montag

Filassi

et al. 2014

WJCO

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Nipple-sparing mastectomy (NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon and In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon' s experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast reconstruction; Skin-sparing mastectomy; Nipple-sparing mastectomy; Outcome; Complications; Silicone breast implants; Tissue expanders; Oncoplastic surgery Core tip: In selected patients, nipple-sparing mastectomy (NSM) has allowed an adequate oncologic control with satisfactory aesthetic outcome. In addition, utilizing the native breast skin optimizes the aesthetic outcome of the reconstructed breast and minimizes postmastectomy deformity. The satisfactory results are due to a close collaboration with the oncological surgical ed the technique for benign diseases, however he did not report the procedure for oncological objectives or as a risk-reduction alternative [10,11] . Recently, there has been an increase in clinical experience studies of NSM for breast cancer prophylaxis or early cancer treatment, evidencing revived interest in this surgical procedure [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][33][34][35][36][37][38][39][40][41][42][43...

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Section: Two-stage Approachmentioning

confidence: 99%

Section: Two-stage Approachmentioning

confidence: 99%

Section: Two-stage Approachmentioning

confidence: 99%

Section: Two-stage Approachmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Munhoz

Montag

Filassi

et al. 2014

WJCO

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Nipple-sparing mastectomy: A contemporary perspective

Sisco

Yao

2016

J. Surg. Oncol.

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Nipple‐areola‐complex preservation and obesity—Successful in stages

et al. 2023

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BackgroundThe superiority of nipple‐sparing mastectomy (NSM) on breast aesthetics and patient‐reported outcomes has previously been demonstrated. Despite 42.4% of adults in the United States being considered obese, obesity has been considered a contraindication to NSM due to concerns for nipple areolar complex (NAC) malposition or ischemic complications. This report investigates the feasibility and safety of a staged surgical approach to NSM with immediate microsurgical breast reconstruction in the high‐risk obese population.MethodsOnly patients with a body mass index (BMI) of >30 kg/m2 who underwent bilateral mastopexy or breast reduction for correction of ptosis or macromastia (stage 1), respectively, followed by bilateral prophylactic NSM with immediate microsurgical breast reconstruction with free abdominal flaps (stage 2) were included in the analysis. Patient demographics and surgical outcomes were analyzed.ResultsFifteen patients with high‐risk genetic mutations for breast cancer with a mean age and BMI of 41.3 years and 35.0 kg/m2, respectively, underwent bilateral staged NSM with immediate microsurgical breast reconstruction (30 breast reconstructions). At a mean follow‐up of 15.7 months, complications were encountered following stage 2 only and included mastectomy skin necrosis (5 breasts [16.7%]), NAC necrosis (2 breasts [6.7%]), and abdominal seroma (1 patient [6.7%]) all of which were considered minor and neither required surgical intervention nor admission.ConclusionsImplementation of a staged approach permits NAC preservation in obese patients who present for prophylactic mastectomy and immediate microsurgical reconstruction.

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Breast Reconstruction Using a Staged Nipple-Sparing Mastectomy following Mastopexy or Reduction

Abstract: Therapeutic, IV.

Cited by 127 publications

References 26 publications

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Nipple-sparing mastectomy: A contemporary perspective

Nipple‐areola‐complex preservation and obesity—Successful in stages

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