Nipple-sparing mastectomy and immediate free-flap reconstruction in the large ptotic breast.
نویسندگان
چکیده
Because of increased risk for nipple necrosis, many surgeons believe large ptotic breasts to be a relative contraindication to nipple-sparing mastectomy (NSM). A retrospective review was performed on 85 consecutive patients who underwent NSM with 141 immediate perforator free-flap breast reconstructions. We analyzed the subset of patients with large ptotic breasts, defined as cup size C or greater, sternal notch to nipple distance greater than 24 cm and grade 2 or 3 breast ptosis. Of the 85 patients, 19 fit the inclusion criteria. Breast cup size ranged from 34C to 38DDD. There was 1 case of nipple necrosis in the patient with previous breast radiation (5%), 1 hematoma (5%), and no flap losses. Five (26%) patients underwent subsequent mastopexy or breast reduction, a mean of 6.6 months after the primary procedure. We demonstrate that NSM and free-flap breast reconstruction can be safely and reliably performed in selected patients.
منابع مشابه
Breast reconstruction using a staged nipple-sparing mastectomy following mastopexy or reduction.
BACKGROUND To address those patients who do not meet anatomical criteria for nipple-sparing mastectomy, the authors use a staged approach: (1) mastopexy or breast reduction, (2) nipple-sparing mastectomy through the mastopexy incisions after a minimum of 3 to 4 weeks, and (3) the final reconstruction. METHODS Fifteen patients underwent nipple-sparing mastectomy at Georgetown University Hospit...
متن کاملSurgical Delay Facilitates Pedicled Nipple-sparing Mastectomy and Reconstruction in the Ptotic Patient
Significant ptosis is a relative contraindication for nipple-sparing mastectomy and reconstruction. Repositioning of the nipple on the reconstructed breast is best accomplished using a pedicled approach that is risky in the immediate setting. We utilized a surgical delay before reconstruction that allowed for repositioning of the nipple-areola complex on an inferior pedicle. This also allows fo...
متن کاملMicrosurgical breast reconstruction for nipple-sparing mastectomy.
BACKGROUND Nipple-sparing mastectomy warrants thorough preoperative evaluation to effectively achieve risk reduction, high patient satisfaction, and improved aesthetic outcome. To the authors' knowledge, this review represents the largest series of microsurgical breast reconstructions following nipple-sparing mastectomies. METHODS All patients undergoing nipple-sparing mastectomy with microsu...
متن کاملNipple-Sparing Mastectomy and Ptosis: Perforator Flap Breast Reconstruction Allows Full Secondary Mastopexy with Complete Nipple Areolar Repositioning
BACKGROUND Patients with moderate to severe ptosis are often considered poor candidates for nipple-sparing mastectomy. This results from the perceived risk of nipple necrosis and/or the inability of the reconstructive surgeon to reliably and effectively reposition the nipple-areola complex on the breast mound after mastectomy. METHODS A retrospective review identified patients with grade II/I...
متن کاملSurgical Delay of the Nipple–Areolar Complex in High-risk Nipple-sparing Mastectomy Reconstruction
As nipple-sparing mastectomy gains increasing popularity, minimizing the risk of nipple necrosis continues to be of critical importance to patients and surgeons. Patients with large or ptotic breasts, scars from previous cosmetic and/or oncologic breast surgery, or previous irradiation have often been denied nipple-sparing mastectomy (NSM) because of increased risk of nipple necrosis. A variety...
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ورودعنوان ژورنال:
- Annals of plastic surgery
دوره 69 4 شماره
صفحات -
تاریخ انتشار 2012