Targeted Two Stage Risk Reducing Mastopexi/Reduction and Straight to Implant NSM

Nipple sparing mastectomy (NSM) with simultaneous hammock technique straight to implant reconstruction (IBR) is a good method for the reconstruction of risk reduction patients. The emphasis of patient selection is paramount for optimal results and fewer complications.  In spite of the promising method, patients with macromastia, ptosis and other breast deformities remain a challenging group to treat satisfactorily and more often end up having a difficult corrective procedure and unacceptably high rate of failed reconstruction. 

Material and method

A cohort series of 20 patients, median age 43 years (26 to 57), were offered a pre-shaping Mastopexy/reduction  followed by a delayed NSM/IBR.   The aim of the study was to test its effect on NAC survival and the primary outcome measure was partial or total nipple necrosis and accomplished reconstruction and secondary outcome measures were;  infection, hematoma, skin necrosis and wound dehiscence. The time span from mastopexy/reduction to NSM/IBR was registered and length of follow-up from NSM along with patient parameters. 

Results

Reconstruction was achieved without any failure or NAC losses in all 40/40 breasts, 20 bilateral targeted two stage risk reducing mastopexy/reduction and  NSM/IBR procedures. The median BMI was 30.  Six patients were smokers and one had hypertension.  Anatomical shaped silicone implants were used in all patients, average size 555 cc, (310 to 690). Average or time for NSM/IBR was 125 minutes ( 90 to 235).  The median time between procedures was  133days, ( 105-266). Two patients had a re-operation due to haematoma and fat necrosis. Five patients had minor complications.  The median follow-up is currently 220 days (30 to 602).

Conclusion

Targeted two stage risk reducing mastopexy/reduction followed by straight to implant NSM has proven to be a successful method to overcome the drawbacks of NSM on the challenging breasts.   It can be planned and performed safely with a timespan of three to four months between surgeries. It is possible that the NAC is pre-conditioned by the two stage approach, as we did not experience any vascular compromise or necrosis there of?  The shape and appearance of the breasts were better than we had expected.