Nipple-Sparing Skin-Reducing Mastectomy for Women with Large and Ptotic Breasts: a 6-Year, Single-Centre Experience with the Bipedicled Dermal Flap Approach

Abstract

We are reporting outcomes of our 6-year experience with a modification of McKissock’s bipedicled mastopexy reduction approach to perform nipple-sparing skin-reducing mastectomy (NSSRM) and immediate implant-based reconstruction in patients with large, ptotic breasts. Personal design and surgical approach of two senior surgeons (RB and IFR) are reported. Patient inclusion criteria are as follows: tumour situated > 1 cm from the nipple, sternal notch to nipple distance 26–33 cm, grade 3 ptosis, patient choice. Between 2010 and 2016, a total of 30 double-pedicle NSSRM and immediate implant-based reconstructions were performed in 20 patients with grade 3 ptosis. Fifteen had cancer and 5 risk reduction. Median follow-up was 3.5 years. There was a single case of full thickness nipple necrosis. Three had superficial nipple necrosis/epidermolysis. Two required nipple excision due to histology. Four had unplanned implant removal, 3/4 loss occurred post-radiotherapy. There were no cases of local recurrence. BREAST-Q questionnaire mean score for ‘satisfaction with breasts’ was 69 (± 20). This technique allows performing single-stage implant-based immediate reconstruction in women that traditionally were not considered suitable for such operation. Results have acceptable clinical outcomes with low rate of nipple necrosis and excellent patient-reported outcomes.