P2-16-12: Skin Reducing Nipple Sparing Mastectomy – A Treatment Option for Patients with Significant Ptosis or Macromastia.

Abstract

Abstract Background: With new data showing the oncologic safety of nipple sparing mastectomy with immediate reconstruction - nipple sparing mastectomies are now offered to an increasing number of mastectomy patients. Unfortunately cosmetically acceptable reconstruction of nipple sparing mastectomies is technically limited to women with perfect breast anatomy - where the skin envelope shows no or little redundancy and where the nipple areolar complex is located in the perfect location on the breast mount. Especially in countries with a high incidence of obesity and associated macromastia only a small percentage of women fall into this category. A high percentahge of patients who would otherwise be good candidates for nipple sparing procedures are excluded based on their unfavorable breast anatomy. We describe a surgical technique that reduces the redundant mastectomy skin envelope in a breast reduction pattern and places the native nipple areolar complex as a free skin graft into proper anatomical position. This technique in conjunction with implant or autologous reconstruction combines the benefits of shorter better vascularized skin flaps with the cosmetic and emotional benefits of preserving the nipple areolar complex even in the anatomically difficult cases. Methods: To investigate the safety and efficiency of this method we reviewed medical records of 40 patients who underwent 60 nipple preserving skin reducing mastectomies over the last 4 years. All procedures were performed by the senior author and follow up ranged from 4 weeks to 50 months. The charts were analyzed for the occurrence of complications such as infection, seroma, hematoma, mastectomy flap necrosis, nipple-areolar loss and loco regional recurrence. All patients were asked to rate their reconstruction on a scale of poor- good - excellent. Results: In 60 reconstructed breasts we encountered one case of seroma, four cases of limited mastectomy flap necrosis treated with local wound care and one case of partial areolar necrosis treated with local excision. No loco regional recurrences, hematomas or infections were encountered. Out of the group of 40 patients, 31 patients rated their result as excellent, 8 as good, and one as poor. Conclusion: Our results compare favorably with data published in the literature. Patient satisfaction rates are high and complication rates are low in a patient population that historically has been a challenge for the breast surgeon, as well as, the plastic surgeon. The use of a skin reducing mastectomy in conjunction with a free nipple graft enables the breast surgeon to offer nipple sparing procedures for all patients who are good oncological candidates regardless of their breast anatomy. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-12.