The “Smile Mastopexy”: A Novel Technique to Aesthetically Address the Excess Skin Envelope in Large, Ptotic Breasts While Preserving Nipple Areolar Complex During Prosthetic Breast Reconstruction

Abstract

Background Classically large, ptotic breasts have been a contraindication for nipple preservation during breast reconstruction. We present our technique of “Smile Mastopexy” to address some of these issues. This reduces the excess skin in both vertical and transverse directions, avoids a “T-junction”, preserves the nipple areolar complex, and adds thickness to the upper pole of the breast at the time of mastectomy. Objectives To demonstrate the safety and reliability of a novel technique that addresses the excess skin envelope during breast reconstruction, while preserving the NAC in large, ptotic breasts. Methods This is a retrospective review of a single surgeon performing the “Smile Mastopexy” for immediate 2 stage prosthetic breast reconstruction. All were performed in the pre-pectoral pocket without the use of acellular dermal matrices. Results Our study included 30 patients and a total of 54 breasts with a mean age of 50 years, BMI of 30 kg/m 2, and mastectomy specimen weight of 683 grams. All had class 2 or 3 ptosis. There were no cases of complete nipple loss. Overall complication rate was 14.8%. There were 3 explantations, with 1 (1.8%) being due to infection and 2 (3.7%) due to implant exposure. Radiation was associated with a higher complication rate. Patients reported outcomes were evaluated using the Breast-Q questionnaire. Conclusions The “Smile Mastopexy” is a safe and reliable technique in large, ptotic breasts during prosthetic breast reconstruction. It preserves the NAC, reduces the excess skin envelope, adds thickness to the upper pole, and allows for future skin revisions using the same scar if necessary.

Modified Bidirectional Adipodermal Mastopexy, Nipple-sparing Mastectomy, and Direct-to-implant Reconstruction in Patients with Significant Ptosis

“…She is awaiting left nac reconstruction. adipodermal pedicle reports included four descriptions that were not Wise-patterns, 6,[17][18][19] eliminating the vertical scar and placing the scar across the center of the breast 18,19 or at the IMF. 6,17 Three inferiorly based adipodermal pedicle reports describing leaving subareolar tissue behind 6,13,14 to support NAC perfusion, one of which required a second surgery for removal.…”

“…Other studies did not commit to a unidirectional adipodermal pedicle and kept most attachments intact, 32–35 which limited the extent of nipple repositioning possible. Some studies modified the mastopexy pattern to eliminate the T-junction and placed an incision in the IMF 6,17 or across the breast 18,19,28,35 to reduce the incidence of mastectomy flap/T-junction necrosis. The adipodermal flaps described were inferiorly based (9)‚ 6,12–19 bidirectional (8), 23,27–31 superiorly based (4), 22–25 medially based (2), 20,21 and no direction specified (4).…”

“…Movassaghi and Stewart 19 described the “smile mastopexy” in 54 patients undergoing therapeutic NSM and prepectoral TE reconstruction. Central breast skin was deepithelialized using a transverse “smile pattern” and then closure left a horizontal scar at Pitanguy’s point with the NAC supported on a broad-based inferior pedicle.…”

“…We reviewed all published reports on this topic to come to some conclusion as to what the best strategy might be. Using the methodology described in the Methods section, we identified 25 original publications 6,12–35 that described an approach to NSM and simultaneous mastopexy in patients with ptosis. We discuss our outcomes compared with previous reports describing therapeutic NSM and immediate mastopexy, focusing on publications with the largest case numbers (Table 3).…”

Implant-Based Breast Reconstruction after Mastectomy, from the Subpectoral to the Prepectoral Approach: An Evidence-Based Change of Mind?

“…In selected cases, these flaps can also be used to stabilize the implant in its subcutaneous pocket. In addition, new incision patterns continue to be described with the intention to perfect this technique [ 47 , 48 ]. Another interesting approach is the technique of “preshaping” [ 49 , 50 , 51 ].…”