Immediate prepectoral breast reconstruction in nipple-sparing mastectomy with Wise-pattern incision in large and ptotic breasts: Our experience and short-term results

Abstract

IntroductionCurrent trends in treatment of breast cancer advocate nipple-sparing mastectomy (NSM) as the technique of choice in selected patients. A large and ptotic breast is often considered a relative contraindication for NSM, due to the increased risk of skin and nipple necrosis. MethodsA retrospective review was performed for patients who underwent immediate prepectoral breast reconstruction (PPBR) after NSM with Wise-pattern incision between February 2020 and February 2023 at our institution. This procedure was offered to patients with grade II or III ptosis or large breasts who were candidates to NSM for therapeutic or prophylactic purpose. Exclusion criteria were: a preoperative nipple-sternal notch distance greater than 30cm, previous radiotherapy, pinch test < 1cm, BMI greater than 34 and active smoke. We present our short-term results with this technique. ResultsDuring the considered period, 62 patients (76 breasts) had NSM with Wise-pattern incision. Patients had immediate PPBR with implant or tissue expander, both entirely wrapped with ADM. The median age of the patients was 57.0 years (IQR 50.0-68.6) with a median BMI of 25.5 (IQR 23.3-28.4). The median mastectomy specimen weight was 472g (341-578). Median implant volume was 465g (IQR 370-515). Major complications occurred in 8 patients (10.5%). Three patients had total NAC necrosis (3.9%), partial NAC necrosis occurred in 2 patients (2.6%). Two patients developed implant infection (2.6%). Univariate analysis showed a statistically significant correlation between major complications and the mastectomy specimen weight (p 0.003). ConclusionsIf oncologically indicated, NSM with Wise-pattern incision and immediate PPBR can safely be performed in selected patients with large and ptotic breasts.