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Mastopexy/Reduction Mammoplasty after Nipple Sparing Mastectomy and Breast Reconstruction Using Autologous Tissue: Is it safe?
Introduction:
Breast and plastic surgeons have refined operative techniques to ensure the best oncological and cosmetic results for breast reconstruction. Results of staged operations in an attempt to improved cosmetic outcomes are very promising. However, to date there is no literature describing mastopexy techniques following NSM with autologous reconstruction. Thus, we report our experience with “lifting” the autologous reconstructed breast.
Method:
Thirty patients with grade one or two ptosis were included in our experience. Pre-operatively degree of ptosis was recorded. All had autologous reconstruction with abdominal perforator artery flaps followed by either wise pattern, circumareolar or circumvertical mastopexy. Post-operatively all patients were examined at 2, 4, 6 and 8 weeks, then semi-annually. All complications were documented with particular attention to nipple viability and post-operative degree of ptosis.
Results:
Thirty patients (50 reconstructed breasts) underwent “autologous lift”. Post-operatively all had non-ptotic breasts. Two patients had minor wound complications and one patient had partial nipple loss.
Discussion:
NSM can safely be offered to patients with moderate to severe ptosis with immediate autologous breast reconstruction followed by a staged mastopexy/reduction. After free flap reconstruction, the blood supply of the nipple is dependent on the underlying flap and less dependent on the peripheral cutaneous circulation which allows movement of the nipple based solely on the blood supply of the reconstructed breast.
Conclusion:
Mastopexy of the autologous reconstructed breast performed after nipple sparing mastectomy can be safely performed. The viability of the nipple can be maintained based solely on the vasculature of the free flap.