Concurrent Skin Reduction in Nipple Sparing Mastectomy and Immediate Tissue Expander Reconstruction for Grade Three Ptosis Breasts

However, not all women are candidates for the operation. From an oncologic perspective, NSM is limited to women with small, early stage peripheral cancers [1, 2]. From a plastic surgery perspective, the NSM is typically offered to women with small breasts and minimal ptosis. The large breasted woman with significant ptosis faces risks with this operation, including NAC and skin necrosis due to poor perfusion to the long mastectomy skin flaps, NAC malposition, and poor contour and profile of the breast due to redundant skin.