Outcomes Using Two Unique Methods of Immediate Implant-Based Breast Reconstruction After Nipple-Sparing Mastectomy in Ptotic Patients
Zachary Erlichman1, Justin Buro, MD1, Minah Waraich2, Haritha Veeramachaneni3
1 Stony Brook University Hospital Stony Brook, NY, 2 Stony Brook University Stony Brook, NY, 3 LIPSG Garden City, NY
Objective: Following nipple-sparing mastectomy (NSM) and immediate implant-based reconstruction, patients with ptosis are at risk for nipple-areolar complex necrosis (NAC). This study aims to evaluate complications utilizing either a Wise incision or Batwing incision with inferior dermal flap and simultaneous peri-areolar mastopexy.
Materials and Methods: A retrospective chart review was conducted on all patients who underwent NSM and immediate implant reconstruction utilizing the methods described by a single surgeon between 2016 and 2021. Outcomes were assessed by comparing average complications rates.
Results: 43 reconstructions performed after NSM in patients with ptosis. 16 reconstructions utilized the wise incision and inferior dermal flap while 27 other reconstructions involved a Batwing incision. For the cases involving a Wise incision, NAC necrosis occurred in 43.8%, while mastectomy skin flap necrosis occurred in 0%, dehiscence in 12.5%, and implant loss in 0%. For the cases involving a Batwing incision, NAC necrosis occurred in 11.1%, while mastectomy skin flap necrosis occurred in 0%, dehiscence in 0%, and implant loss 3.7%. Aesthetic outcomes were acceptable for most of the cases involving NAC necrosis.
Conclusion: A revised method involving a Batwing pattern incision, inferior dermal flap, and mastopexy is a more effective method of immediate reconstruction after NSM in patients with ptosis according to these findings. NAC necrosis continues to be a major complication that is important to discuss with patients. However, these methods offer patients with ptosis the benefit of preserving native NAC while allowing for other techniques utilized in patients with ptosis.
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